The Effectiveness of Endometrial Receptivity Test for Repeated Implantation Failure and Analysis of Clinical Factors Affecting Implantation Window
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摘要:
目的 利用子宫内膜容受性检测技术（endometrial receptivity test，ERT）对反复种植失败的患者实施个性化移植探讨该技术对于改善此类患者临床结局的有效性，同时分析影响内膜容受性的临床因素。 方法 回顾性队列研究2020年12月至2021年11月期间于云南省第一人民医院生殖医学科诊断为反复移植失败病例的临床资料。根据是否接受子宫内膜容受性检测技术并按检测结果再次移植胚胎分为接受组和未接受组，比较2组间的临床结局。分析影响内膜容受性的临床因素。 结果 接受组再次移植临床妊娠率及胚胎种植率均显著高于同期未接受组（P < 0.05）。多因素回归分析显示，合并多囊卵巢综合征及发生卵泡未破裂黄素化是种植窗移位的影响因素（P < 0.05）。 结论 对于反复种植失败的患者，依据ERT检测结果移植能改善助孕结局；合并多囊卵巢综合征及发生卵泡未破裂黄素化是反复种植失败患者发生种植窗移位的危险因素。 Abstract:Objective To investigate the efficacy of personalized transplantation of Endometrial Receptivity Test （ERT） in improving the clinical outcome of patients with repeated implantation failure, and to analyze the clinical factors affecting Endometrial Receptivity. Methods A retrospective cohort study was conducted on the clinical data of patients diagnosed with repeated transplantation failure in the Reproductive Medicine Department of the First People’s Hospital of Yunnan from December 2020 to November 2021. The patients were divided into two groups according to whether or not they had undergone endometrial receptivity testing and retransplanted embryos according to the test results. The clinical outcomes were compared between the two groups. The clinical factors affecting the endometrial receptivity were[ 1 ] analyzed.Results The clinical pregnancy rate and embryo implantation rate in the receiving group were significantly higher than those in the non-receiving group （P < 0.05）. Multivariate regression analysis showed that polycystic ovary syndrome and the occurrence of follicular unruptured luteinization were the influencing factors of implantation window shift （P < 0.05）. Conclusion For patients with repeated implantation failure, transplantation can improve the outcome of assisted pregnancy according to ERT test results; Polycystic ovary syndrome and luteinization of unruptured follicles are risk factors for the implantation window displacement in patients with repeated implantation failure. -
表 1 2组病例一般资料的比较[（
$\bar x \pm s $ ）/n（%）]Table 1. Comparison of general data of two groups of cases [（
$\bar x \pm s $ ）/n（%）]项目 接受组 未接受组 χ2 /t P 年龄（岁） 33.60 ± 2.84 33.34 ± 2.78 0.385 0.701 BMI（kg/m2） 22.40 ± 2.50 21.92 ± 2.29 0.842 0.402 不孕类型（原发不孕占比） 22（51.16） 13（44.83） 0.278 0.598 多囊卵巢综合征占比 6（13.95） 5（17.24） 0.145 0.704 子宫内膜异位症占比 4（9.30） 2（7.00） 0.131 0.717 移植胚胎数（个） 1.40 ± 0.50 1.59 ± 0.50 −1.597 0.115 囊胚占比 20/43（46.51） 14/29（48.28） 0.022 0.883 移植日内膜厚度（mm） 9.21 ± 1.57 9.14 ± 1.34 0.201 0.841 
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表 2 2组病例临床妊娠率和胚胎种植率比较n[（%）]
Table 2. Comparison of clinical pregnancy rate and embryo implantation rate between two groups [n（%）]
项目 接受组 未接受组 x2 /t P 临床妊娠率 23（53.39） 7（24.14） 6.138 0.013* 胚胎种植率 28（46.67） 9（20.00） 8.013 0.005* *P < 0.05。
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表 3 影响种植窗移位的多因素回归分析结果
Table 3. Regression analysis results of multiple factors affecting the displacement of planting window
变量 单因素分析 多因素分析 OR 95%CI P OR 95%CI P 年龄 0.908 0.720～1.146 0.417 BMI 1.211 0.958～1.533 0.109 不孕类型 0.722 0.208～2.504 0.608 宫外孕史 0.383 0.039～3.700 0.411 PCOS 11.818 1.233～113.233 0.032* 14.114 1.265～157.496 0.031* 子宫内膜异位 0.383 0.039～3.770 0.411 LUF 7.500 1.290～43.608 0.025* 8.244 1.180～57.589 0.033* 内膜厚度 1.120 0.707～1.775 0.628 血孕酮水平 0.607 0.396～0.931 0.022* 0.731 0.462～1.154 0.179 *P < 0.05。
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