经阴道彩色多普勒超声在IVF-ET中对子宫内膜容受性的评估价值

目的:探讨经阴道彩色多普勒超声(TVCD)检测子宫动脉血流动力学、内膜厚度及形态变化能否评估移植前子宫内膜容受性。方法:回顾性分析119个体外受精一胚胎移植(IVF-ET)周期,TVCD检测注射绒毛膜促性腺激素(hCG)日和取卵日子宫动脉血流的搏动指数(PI)和阻力指数(RI)、子宫内膜厚度和形态,分析各个参数变化与临床妊娠的关系。结果:119个IVF-ET周期,临床妊娠率为33.61%(40/119)。妊娠组在hCG日PI和RI显著低于非妊娠组,取卵日妊娠组PI显著低于非妊娠组,RI无差异,hCG日妊娠组内膜厚度显著大于非妊娠组,内膜厚度<8mm者无一例妊娠,妊娠组内膜形态以多层为主。结论:hCG日子宫动脉PI和RI越低,血管阻力也越低,子宫血流灌注良好,获得妊娠机会较大,8mm以上多层内膜适宜胚胎着床,即TVCD对评估子宫内膜容受性有重要意义。

Evaluation of Endometrial Receptivity during In Vitro Fertilization and Embryo Transfer Using Trans-vaginal Color Doppler Ultrasonography

Objective: To assess endometrial receptivity before embryo transfer (ET) by uterine artery blood flow, endometrial thickness and pattern in trans-vaginal color doppler ultersonography (TCVD). Methods: 119 cycles of in vitro fertilization and embryo transfer (IVF-ET) were retrospectively analyzed. The pulsate index (PI), resistance index (RI) and endometrial thickness and pattern on the day of human chorionic gonadotropin(hCG) and oocyte retrieval were measured in TCVD. Change of every parameter and relationships between them and clinical pregnancy were analyzed. Results: The rate of clinical pregnancy was 33.61% (40/90) in 119 cycles of IVF-ET. PI and RI on the day of hCG in pregnancy group were significantly lower than those of non-pregnancy group. PI on the day of oocyte retrieval in pregnancy group was significantly lower than that of non-pregnancy group, whereas the change of RI in two groups was no difference. The endometrium of pregnancy group on the day of hCG was thicker than that of non-pregnancy group, and there was no pregnancy in less 8 mm endometrium. The main pattern of endometrium was multilayer in pregnancy group. Conclusion: On the day of hCG, the lower PI and RI are, the better uterine artery blood flow is and the higher pregnancy rate is. Endometrial thickness greater than 8 mm is of advantage to embryo imbedding. Namely, TVCD is a valuable way of evaluation of uterine receptivity.