种植窗期子宫动脉及内膜下血流血流参数与IVF-ET结局的研究
发布时间：2018-12-18 16:44
【摘要】：目的通过彩色多普勒超声监测种植窗期子宫动脉及子宫内膜下血流血流动力学指标,分析子宫动脉及内膜下血流血流动力学参数与体外受精/卵细胞浆内单精子显微注射-胚胎移植(IVF/ICSI-ET)结局的关系,探讨其对子宫内膜容受性的预测价值,为反复种植失败者提供超声学依据,同时为无优质胚胎移植者探索新的治疗思路。方法收集2015年8月-2015年12月在宁夏医科大学总医院生殖医学中心实施IVF/ICSI-ET助孕的患者100例。根据胚胎移植后14天血清HCG结果分为研究组(HCG≥25IU/ml)共48例,对照组(HCG25IU/ml)共52例。再由助孕方案分为鲜胚移植组(ET组)47例,冻胚移植组(FET组)53例。应用化学发光法测定生殖激素水平,经阴道彩色多普勒超声测定子宫动脉/内膜下血流血流指标:收缩期峰值流速(PSV),舒张期末流速(EDV),收缩期峰值流速/舒张末期流速(S/D),阻力指数(RI),搏动指数(PI)。SPSS18.0统计软件分析,计量资料用t检验,计数资料X2检验,用AUC判断子宫动脉及内膜下血流RI临床预测价值。结果(1)研究组和对照组的ET者种植窗期子宫内膜厚度明显高于FET者(12.86±2.48vs.10.81±2.41,12.45±2.26vs.10.74±2.56,均p0.01)。(2)研究组子宫动脉及内膜下血流RI值均明显低于对照组(0.69±0.09vs.0.82±0.33,0.72±0.11vs.0.77±0.15,均p0.05),但二者RI的ROC曲线下面积均小于参考下面积(p0.01)。(3)研究组中优质胚胎移植者的子宫动脉及内膜下血流RI值明显低于对照组(0.68±0.09vs.0.83±0.36,0.70±0.11vs.0.78±0.16,均p0.05),RI的ROC曲线下面积均小于参考面积(p0.01)。(4)ET中,研究组基础LH值显著高于对照组(4.01±1.64vs.2.70±1.27,p0.05);且ROC曲线下面积大于参考面积(p0.05)。(5)在FET周期中,研究组子宫动脉RI显著低于对照组(0.69±0.11 vs.0.85±0.41,p0.05)。(6)双胎妊娠者子宫动脉/内膜下血流RI略低于单胎妊娠者(p0.05)。结论(1)子宫动脉及内膜下血流RI值可做为预测胚胎移植结局的参考指标。(2)通过改善子宫动脉及内膜下血流血流灌注对提高非优质胚胎移植的妊娠率可能存在潜在的临床应用前景。(3)2个或以上优质胚胎移植者,移植日子宫动脉/内膜下血流低RI者也更容易发生多胎妊娠。(4)超生理剂量的E2水平不是影响子宫内膜血流动力学的因素,E2/P为一项调节因子。(5)基础LH是影响鲜胚移植妊娠结局的因素之一,当基础LH2.58m IU/ml时,妊娠率明显下降。
[Abstract]:Objective to monitor the uterine artery and subendometrial hemodynamics in the implantation window by color Doppler ultrasound (CDFI). To analyze the relationship between uterine artery and subendometrial hemodynamic parameters and the outcome of in vitro fertilization / intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET), and to explore its predictive value for endometrial receptivity. To provide ultrasonic basis for repeated implantation failure, and to explore a new treatment for those without high quality embryo transfer. Methods from August 2015 to December 2015, 100 cases of IVF/ICSI-ET assisted pregnancy were collected from the Center of Reproductive Medicine, General Hospital of Ningxia Medical University. According to the results of serum HCG 14 days after embryo transfer, 48 cases of study group (HCG 鈮，
本文编号：2386134
[Abstract]:Objective to monitor the uterine artery and subendometrial hemodynamics in the implantation window by color Doppler ultrasound (CDFI). To analyze the relationship between uterine artery and subendometrial hemodynamic parameters and the outcome of in vitro fertilization / intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET), and to explore its predictive value for endometrial receptivity. To provide ultrasonic basis for repeated implantation failure, and to explore a new treatment for those without high quality embryo transfer. Methods from August 2015 to December 2015, 100 cases of IVF/ICSI-ET assisted pregnancy were collected from the Center of Reproductive Medicine, General Hospital of Ningxia Medical University. According to the results of serum HCG 14 days after embryo transfer, 48 cases of study group (HCG 鈮，
本文编号：2386134
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