不孕症患者子宫内膜息肉发生风险因素及其对助孕结局影响的研究

文雯; 涂晓娟; 马永毅; 李玉艳; 蒋承芳; 何畏

doi:10.16016/j.2097-0927.202312022

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不孕症患者子宫内膜息肉发生风险因素及其对助孕结局影响的研究

临床医学 | 更新时间：2026-01-09

- 不孕症患者子宫内膜息肉发生风险因素及其对助孕结局影响的研究
- Risk factors and assisted reproductive outcomes in infertility patients with concomitant endometrial polyps
- 陆军军医大学学报 2024年46卷第8期页码：886-893
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院生殖医学中心
- 作者简介：
  
  [何畏，E-mail: anyhewei@163.comHE Wei, E-mail: anyhewei@163.com
- 基金信息：
  
  重庆市社会事业与民生保障科技创新专项基金(cstc2017shms-zdyfX0035)
- DOI：10.16016/j.2097-0927.202312022
  中图分类号： R181.32;R711.6;R711.74
- 收稿：2023-12-05，
  
  修回：2024-02-04，
  
  纸质出版：2024-04-30
- 稿件说明：
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文雯, 涂晓娟, 马永毅, 等. 不孕症患者子宫内膜息肉发生风险因素及其对助孕结局影响的研究[J]. 陆军军医大学学报, 2024,46(8):886-893.

Wen WEN, Xiaojuan TU, Yongyi MA, et al. Risk factors and assisted reproductive outcomes in infertility patients with concomitant endometrial polyps[J]. Journal of Army Medical University, 2024, 46(8): 886-893.
文雯, 涂晓娟, 马永毅, 等. 不孕症患者子宫内膜息肉发生风险因素及其对助孕结局影响的研究[J]. 陆军军医大学学报, 2024,46(8):886-893. DOI： 10.16016/j.2097-0927.202312022.

Wen WEN, Xiaojuan TU, Yongyi MA, et al. Risk factors and assisted reproductive outcomes in infertility patients with concomitant endometrial polyps[J]. Journal of Army Medical University, 2024, 46(8): 886-893. DOI： 10.16016/j.2097-0927.202312022.

摘要

目的

探讨不孕症患者子宫内膜息肉(endometrial polyps

EPs)发生的高危因素

及其对助孕结局的影响。

方法

采用病例-对照研究设计

分析2016年1月至2022年12月接受宫腔镜检查并于术后在我院首次行胚胎移植术的不孕症患者资料。采用单因素和逐步逻辑回归分析不孕患者EPs发生的危险因素

基于倾向性评分(propensity score matching

PSM)1:2匹配分析息肉对辅助生殖妊娠结局的影响。

结果

研究纳入388例确诊EPs并行宫腔镜下子宫内膜息肉切除术患者(EPs组)与2 163例非息肉患者(非EPs组)

单因素分析显示2组在年龄[31(29

34)

31(28

33)岁

=0.002

]

、既往盆腔炎病史(42.78%

64.17%

=0.000)、初潮年龄[14(12

14)

13(12

14)岁

=0.000

]

、孕次数[0(0

1(0

2)次

=0.000

]

、原发不孕(60.30%

50.20%

=0.000)、不孕年限[4(2.1

6.0)年

4(2.0

6.0)年

=0.002

]

、合并子宫内膜异位症(9.53%

6.52%

=0.032)、合并子宫肌瘤(11.85%

6.93%

=0.001)、基础雌激素(basal estrogen

)[38.12(27.00

59.00)μg/L

36.00(25.00

53.00)μg/L

=0.016

]

差异有统计学意义。逐步逻辑回归分析显示: 年龄(

: 1.082

95%

: 1.053~1.113

0.05)、原发不孕(

: 2.951

95%

: 1.990~4.376

0.05)、bE

升高(

: 1.003

95%

: 1.001~1.005

0.05)是EPs发病的危险因素。匹配后EPs组术后生化妊娠率(59.28%

52.70%)、临床妊娠率(53.09%

45.49%)、活产率(43.81%

35.82%)均高于非EPs组(

0.05);息肉位置、大小不同的患者妊娠结局差异无统计学意义(

0.05)

多发息肉患者较单发息肉患者早期流产率更高(17.27%

7.29%

0.05)

复发息肉较首发息肉患者早期流产率更高(27.78%

11.23%

0.05)。

结论

年龄、原发不孕、bE

升高是EPs发生的危险因素。EPs患者在胚胎移植术前行宫腔镜下子宫内膜息肉切除术可获得较好的妊娠结局

EPs的位置与大小对胚胎移植术后妊娠结局的影响较小

但多发和复发性息肉可能会增加早期流产的风险。

Abstract

Objective

To investigate the high risk factors of endometrial polyps (EPs) in infertile patients and its impact on the pregnancy outcome after embryo transfer.

Methods

A case-control trail was conducted on the infertility patients who undergoing embryo transfer in our hospital for the first time after hysteroscopy from January 2016 to December 2022.Their clinical data were collected and retrospectively analyzed.Univariate and stepwise logistic regression analyses were used to identify the risk factors for EPs

and the impact of polyps on the pregnancy outcomes of assisted reproductive pregnancy was analyzed with propensity score matching (PSM) at a 1:2 ratio.

Results

A total of 388 patients diagnosed with EPs and undergoing hysteroscopic endometrial polypectomy were assigned into the EPs group

and 2 163 non-polyp patients were into the non-EPs group.Univariate analysis showed statistical differences were observed in age[31(29

34)

31(28

33)

=0.002

]

history of pelvic inflammatory disease (42.78%

64.17%

=0.000)

age at menarche[14(12

14)

13(12

14) years old

=0.000

]

number of pregnancies[0(0

1(0

=0.000

]

primary infertility (60.30%

50.20%

=0.000)

duration of infertility[4(2.1

6.0)

4(2.0

6.0) years

=0.002

]

concomitant endometriosis (9.53%

6.52%

=0.032)

concomitant uterine fibroids (11.85%

6.93%

=0.001)

and basal estrogen level[38.12(27.00

59.00)

36.00(25.00

53.00)μg/L

=0.016

]

between the 2 groups.Logistic stepwise regression analysis indicated that age (

=1.082

95%

: 1.053~1.113

0.05)

primary infertility (

=2.951

95%

: 1.990~4.376

0.05)

and elevated basal estrogen (

=1.003

95%

: 1.001~1.005

0.05) were risk factors for EPs.The postoperative biochemical pregnancy rate (59.28%

52.70%)

clinical pregnancy rate (53.09%

45.48%)

and live birth rate (43.81%

35.82%) were significantly higher in the matched EPs group than the non-EPs group (

0.05).No statistical difference was observed in pregnancy outcome in the patients with different polyp locations and sizes.The patients with multiple polyps had an obvious higher rat

e of early miscarriage than those with single polyp (17.27%

7.29%

0.05)

while those with recurrent polyps also had a higher rate of early miscarriage than those with primary polyps (27.78%

11.23%

0.05).

Conclusion

Age

primary infertility

and elevated basal estrogen are risk factors for EPs in infertility patients

while hysteroscopic endometrial polypectomy prior to embryo transfer results in improved pregnancy outcomes in those with EPs.The location and size of endometrial polyps have weak impact on pregnancy outcomes following embryo transfer

but

the presence of multiple or recurrent polyps may elevate the risk of early miscarriage.

关键词

Keywords

references

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