子宫内膜内及子宫内膜下血流对胚胎解冻移植周期妊娠结局的影响

目的探讨彩色多普勒能量超声子宫内膜血流检测在预测胚胎解冻移植周期妊娠结局中的作用。方法前瞻性研究2009年6～12月于我中心行胚胎解冻移植(frozen-thawed embryo transfer,FET)者,共744个周期。解冻移植前1天上午彩色多普勒能量超声测量子宫内膜厚度、形态及血流状态。按子宫内膜血流分为3组:未检测到子宫内膜血流;仅可检测到子宫内膜下血流;可检测到子宫内膜内及子宫内膜下血流。随访FET结局,将妊娠结局分为2组:未妊娠组和妊娠组[妊娠组为胚胎移植后14天查血hCG>35 U/L,包括宫内活胎和妊娠结局不良(生化妊娠、异位妊娠、早孕流产)]。结果 744例行胚胎解冻移植,妊娠率为45.6%(339/744),胚胎种植率17.6%(393/2232)。未检测到血流组的宫内活胎率为25.2%(81/321),仅有内膜下血流组49.1%(162/330),内膜内及内膜下均有血流组为77.4%(72/93),内膜内及内膜下均有血流组明显高于另外2组(χ2=84.287、23.556,P均=0.000),仅有内膜下血流组也明显高于未检测到血流组(χ2=39.589,P=0.000)。解冻移植日妊娠组与未妊娠组子宫内膜厚度差异无显著性。妊娠组子宫内膜收缩期最高血流速度/舒张期末血流速度(S/D)、搏动指数(PI)及阻力指数(RI)分别为2.447±0.422、0.941±0.174及0.583±0.074,明显低于未妊娠组2.947±0.406、1.166±0.219、0.651±0.052(t=16.431、15.301、14.667,P均=0.000)。子宫内膜血流S/D、PI、RI的接受者运行曲线(ROC)下面积分别为0.816、0.808及0.818。结论胚胎解冻移植周期子宫内膜内血流存在者妊娠率明显高于未检测到血流者,存在子宫内膜内血流及子宫内膜血流阻力低者,显示较高的临床妊娠率;彩色多普勒能量超声子宫内膜血流检查可作为预测子宫内膜容受性较好的无创检查方法。

Role of Endometrial Blood Flow Assessment with Color Doppler Energy in Predicting Pregnancy Outcome of FET Cycles

Objective To study the role of endometrial blood flow assessment with color Doppler energy in predicting pregnancy outcome of frozen-thawed embryo transfer(FET) cycles. Methods A prospective study on the women(744 cycles) who received FET in our hospital from June to December 2009.Endometrial thickness,echo pattern and blood flow on transvaginal ultrasonography were measured in the morning before transferring.The patients were divided into 3 groups according to the endometrial blood flow: undetectable group,sub-endometrial blood flow group,and endometrial and sub-endometrial blood flows group.The FET results were followed up and then the patients were divided into pregnant and non-pregnant groups in 14 days after embryo transfer,serum hCG>35 U/L,including intrauterine alive embryo and poor pregnancy outcomes(biochemical pregnancy,ectopic pregnancy and early pregnancy loss). Results In the 744 cases of FET,the pregnancy rate was 45.6%(339/744),and embryo implantation rate was 17.6%(393/2232).The rate of alive intrauterine embryo was 25.2%(81/321) in undetectable group,49.1%(162/330) in the sub-endometrial blood flow group,and 77.4%(72/93) in the endometrial and sub-endometrial blood flows group(endometrial and sub-endometrial blood flows group vs.undetectable and sub-endometrial blood flow groups: χ2=84.287 and 23.556,both P=0.000;undetectable group vs.Sub-endometrial blood flow group: χ2=39.589,P=0.000).No significant difference was detected in the endometrial thickness between pregnant and non-pregnant women.In the pregnancy group,the S/D,PI,and RI of endometrial spiral arteries were 2.447±0.422,0.941±0.174,and 0.583±0.074,respectively,which were significantly lower than those in the non-pregnant group(2.947±0.406,1.166±0.219,and 0.651±0.052;t=16.431,15.301,and 14.667,all P=0.000).The AUC of the ROC of S/D,PI,and RI of endometrial blood flow was 0.816,0.808,and 0.818,respectively. Conclusions The pregnancy rate of FET with endometiral blood flow is significantly higher than those with undetectable blood flow;patients with sub-endometrial blood flow,or low-reisistence endometrial blood flow obtain higher clinical pregnancy rate.Color Doppler ultrasonography is an ideal non-invasive examination for detecting endometrial receptivity.