Effect of accurate assessment for uterine cavity environment on outcome of repeated transplantation failures
- Journal of Army Medical University Vol. 44, Issue 6, Pages: 582-588(2022)
- 作者机构：
1.230032 合肥，安徽医科大学海军临床学院
2.100048 北京，中国人民解放军总医院第六医学中心辅助生殖医学中心
3.100700 北京，中国人民解放军总医院第七医学中心妇产医学部
- 作者简介：
- 基金信息：
DOI：10.16016/j.2097-0927.202110069
CLC： R322.65;R372;R711.6Received：13 October 2021，
Revised：2021-11-17，
Published：30 March 2022
- 稿件说明：
移动端阅览
Shujie HAN, Mingming SHU, Chunlan SONG, et al. Effect of accurate assessment for uterine cavity environment on outcome of repeated transplantation failures[J]. Journal of Army Medical University, 2022, 44(6): 582-588.
Shujie HAN, Mingming SHU, Chunlan SONG, et al. Effect of accurate assessment for uterine cavity environment on outcome of repeated transplantation failures[J]. Journal of Army Medical University, 2022, 44(6): 582-588. DOI： 10.16016/j.2097-0927.202110069.
摘要
目的
2
通过对反复移植失败（repeated implantation failure
RIF）患者宫腔微生态和子宫内膜容受性进行检测，并应用其结果指导移植，评估宫腔环境精准检测对反复移植失败患者助孕结局的影响。
方法
2
选取2019年9月至2021年1月在中国人民解放军总医院第六医学中心辅助生殖医学中心行体外受精/卵细胞细胞质内单精子显微注射（
in vitro
fertilization/intracytoplasmic sperm injection
IVF/ICSI）助孕的223例反复移植失败患者为研究对象，根据是否接受宫腔微生态及容受性检测分为试验A组（
n
=70）、试验B组（
n
=80）和对照组（
n
=73）。试
验A组仅接受宫腔微生态检测，试验B组接受宫腔微生态与子宫内膜容受性检测，两组均根据结果调整移植方案；对照组移植周期前不做干预，应用常规移植方案。比较患者基本资料、胚胎移植情况和妊娠结局，分析宫腔微生物联合子宫内膜容受性检测调整移植用药方案与反复移植失败患者妊娠结局的关系。
结果
2
16SrRNA测序结果显示，反复移植失败患者宫腔内检出细菌占58.57%（41/70），非乳杆菌为主导的患者占81.43%（57/70）。在基线资料比较中，患者的年龄、体质指数（BMI）、促卵泡激素（follicle-srimulating hormore
FSH)、转化日子宫内膜厚度、移植胚胎个数差异在试验A、B组和对照组的两两比较中差异均无统计学意义。在妊娠结局比较中，试验A组和对照组的胚胎种植率分别为21.57%和9.09%，试验A组胚胎种植率显著高于对照组（
P
<
0.05），两组的临床妊娠率分别为34.43%和13.92%，试验A组临床妊娠率显著高于对照组（
P
<
0.05），试验B组患者的胚胎种植率为24.78%，临床妊娠率为39.39%，两者均显著高于对照组（
P
<
0.05），但同试验A组相比，试验B组患者的胚胎种植率和临床妊娠率未显著增加。
结论
2
宫腔微生态联合子宫内膜容受性结果指导移植，对反复移植失败患者有明确意义，其中根据宫腔微生态检测结果指导阴道用乳杆菌等药物的预处理可以显著改善反复移植失败患者妊娠结局。
Abstract
Objective
2
To evaluate the impact of accurate detection of the uterine cavity environment on the outcome of assisted pregnancy in patients with repeated transplantation failures by detecting the uterine cavity micro-ecology and endometrial receptivity after using the results to guide transplantation.
Methods
2
A total of 223 patients with repeated transplantation failure who underwent
in vitro
fertilization/intracytoplasmic sperm injection (IVF/ICSI) in the Assisted Reproductive Center of the Sixth Medical Center of Chinese PLA General Hospital from September 2019 to January 2021 were recruited as the research subjects. According to whether they received the uterine cavity micro-ecology and receptivity test
they were divided into experimental group A (
n
=70)
experimental group B (
n
=80) and control group (
n
=73). Experimental group A only received uterine cavity micro-ecology test
and experimental group B received uterine cavity micro-ecology and endometrial receptivity test. These 2 groups adjusted the transplantation plan according to the results of tests. The control group had no interv
ention before the transplantation cycle and received conventional transplantation plan. The basic data of patients
embryo transfer status and pregnancy outcome were compared
and the relationship of uterine cavity microbes combined with endometrial receptivity test and adjustment of transplantation medication regimen with pregnancy outcome was analyzed in the patients with repeated transplantation failures.
Results
2
The 16SrRNA sequencing results showed that 58.57% (41/70) of patients with repeated transplantation failure had bacteria detected in the uterine cavity
and 81.43% (57/70) of patients were non-lactobacillus-dominated. With the comparison of basic data
the differences in the patient's age
body mass index (BMI)
follicle-stimulating hormone (FSH)
endometrial thickness on the day of transformation
and number of embryos transferred were not statistically different in the pairwise comparisons among groups A and B and the control group (
P
>
0.05). In pregnancy outcomes
the embryo implantation rates were 21.57% and 9.09% in the experimental group A and control group
respectively
with that of experimental group A significantly higher than that of the control group (
P
<
0.05). While
the pregnancy rates were 34.43% and 13.92%
respectively
and that of the experimental group A was notably higher than that of the control group (
P
<
0.05). The embryo implantation rate was 24.78%
and the clinical pregnancy rate was 39.39% in the experimental group B
both of which were obviously higher than those of the control group (
P
<
0.05)
but no such differences were seen in the rates between the experimental group A and group B (
P
>
0.05).
Conclusion
2
Uterine cavity micro-ecology combined with endometrial receptivity results to guide transplantation shows clear significance for patients with repeated transplantation failures. Among them
guiding vaginal pretreatment with Lactobacillus and other drugs based on uterine cavity micro-ecology test results can significantly improve clinical outcome of pregnancy.
关键词
Keywords
references
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