Optimal endometrial thickness to maximize live births and minimize pregnancy losses: Analysis of 25,767 fresh embryo transfers
Optimal endometrial thickness to maximize live births and minimize pregnancy losses: Analysis of 25,767 fresh embryo transfers
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DOI：
10.1016/j.rbmo.2018.08.025
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发表时间：
2018-11-01
影响因子：
4
通讯作者：
Coomarasamy, Arri
中科院分区：
文献类型：
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作者：
Gallos, Ioannis D.;Khairy, Mohammed;Coomarasamy, Arri
研究问题：在试管受精治疗中，子宫内膜厚度与妊娠丢失和活产有什么关系，以及优化试管受精结局的最佳阈值是什么？设计：分析了2007至2016年间英国CARE生育集团中心的25,767个试管受精周期的数据。经阴道超声测量促性腺激素刺激时子宫内膜的最大厚度。活体出生率为每胚胎移植一次。结果：子宫内膜厚度小于或等于5 mm时活产率为15.6%，子宫内膜厚度为10 mm时活产率逐渐上升至33.1%。子宫内膜厚度小于或等于5 mm时，妊娠率为41.7%，子宫内膜厚度为10 mm时，妊娠率逐渐下降至26.5%。对最佳子宫内膜厚度阈值的统计建模发现，10 mm或更多的活产儿最大限度地减少了妊娠损失。在调整了年龄、卵母细胞数、移植胚胎数、卵巢刺激方案和活产胚胎质量(粗RR 1.27；95%可信区间1.21至1.33；调整后RR 1.18；95%CI 1.12至1.23)和妊娠损失(粗RR 0.83；95%CI 0.77至0.89；调整RR 0.86；95%可信区间为0.8~0.92。结论：子宫内膜厚度与IVF中的妊娠损失和活产数密切相关，子宫内膜厚度10 mm或以上的最佳阈值可使活产数最大，妊娠损失最小。
Research question: What is the association of endometrial thickness with pregnancy losses and live births in IVF treatment and the optimal threshold that optimizes the IVF outcome?Design: Data were analysed from 25,767 IVF cycles from centres of the CARE Fertility Group in the UK between 2007 and 2016. Transvaginal ultrasound was conducted to measure the maximum endometrial thickness during gonadotrophin stimulation. Live birth rates were per embryo transfer. Pregnancy loss rates included the combination of biochemical and clinical pregnancy losses.Results: The live birth rate was 15.6% with 5 mm or less endometrial thickness and gradually increased to 33.1% with an endometrial thickness of 10 mm. On the other hand, the pregnancy loss rate was 41.7% with 5 mm or less endometrial thickness and gradually decreased to 26.5% with an endometrial thickness of 10 mm. Statistical modelling for optimal endometrial thickness threshold found 10 mm or more maximized live births and minimized pregnancy losses. This association was independent after adjusting for confounders such as age, oocyte number, number of transferred embryos, ovarian stimulation protocol and embryo quality for live births (crude RR 1.27; 95% CI 1.21 to 1.33; Adjusted RR 1.18; 95% CI 1.12 to 1.23) and pregnancy losses (crude RR 0.83; 95% CI 0.77 to 0.89; adjusted RR 0.86; 95% CI 0.8 to 0.92).Conclusions: Endometrial thickness is strongly associated with pregnancy losses and live births in IVF, and the optimal endometrial thickness threshold of 10 mm or more maximized live births and minimized pregnancy losses.