薄型子宫内膜合并甲状腺功能减退不孕患者的辅助生育治疗结局

目的探讨薄型子宫内膜合并甲状腺功能减退不孕患者行辅助生育治疗后的效果。方法 165例因新鲜周期内膜≤7 mm而取消胚胎移植的不孕患者,在拟行冻融胚胎移植前,对游离甲状腺素T4(FT4)正常、促甲状腺激素(TSH)2.5 mIU/L的患者进行左旋甲状腺素片干预治疗。经治疗4~8周后,患者依据TSH水平分为A组(n=70),TSH2.5 mIU/L;B组(n=95),TSH≤2.5 mIU/L。所有患者均采用相同剂量激素替代方案准备子宫内膜,分析子宫内膜情况及辅助生育结局。结果 A组与B组相比,虽然子宫内膜下血流数量和阻力指数(RI)组间无统计学差异(P0.05),但B组内膜下血流数量的均值高于A组,RI均值低于A组。且B组的子宫内膜厚度、临床妊娠率显著高于A组(P0.05),流产率显著低于A组(P0.05)。结论薄型子宫内膜合并TSH升高的不孕患者,给予干预至TSH2.5 mIU/L后,行辅助生育治疗可改善这些患者的妊娠结局。

Clinical outcome of infertile women with thin endometrium and thyroidism after assisted reproductive treatment

Objective To investigate the clinical outcome of infertile women with thin endometrium and thyroidism after assisted reproductive treatment.Methods Totally 165 infertile women with thin endometrium and thyroidism were enrolled into this study.These women had their fresh embryo transfer canceled due to their endomatrial thickness ≤ 7 ram,and had normal free thyroxin 4 (FT4) and thyroid stimulating hormone (TSH)＞ 2.5 mIU/L.Then they received L-thyroxine for one or two months treatment in order to prepare their frozen-thawed embRyo transfer.Based on their TSH levels,165 infertile women were divided into two groups:group A,n=70,TSH＞2.5 mIU/L;group B,n=95,TSH≤2.5 mIU/L.All cases were given the same dose of estrogen replacement treatment to ready endometrium.Both endometrial status and clinical outcome were compared between the two groups.Results Although the number of endometrial blood flow and resistance index (RI) were not significantly different between groups A and B (P＞0.05),the mean value of endometrial blood flow in group B was higher than that in group A,and the mean value of RI in group B was lower than that in group A.The clinical pregnancy rate and endometrial thickness in group B were significantly higher than those in group A (P＜0.05).Besides,group B had lower abortion rate than group A (P＜0.05).Conclusion Infertile women with thin endometrium and thyroidism could improve their clinical outcome by using assisted reproductive techniques after they underwent L-thyroxine treating and reached normal TSH levels.