The impact of a thin endometrial lining on fresh and frozen-thaw IVF outcomes: an analysis of over 40 000 embryo transfers.
The impact of a thin endometrial lining on fresh and frozen-thaw IVF outcomes: an analysis of over 40 000 embryo transfers.
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DOI：
10.1093/humrep/dey281
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发表时间：
2018-10-01
期刊：
影响因子：
--
通讯作者：
Mahutte N
中科院分区：
文献类型：
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作者：
Liu KE;Hartman M;Hartman A;Luo ZC;Mahutte N
在新鲜和冷冻IVF周期中，子宫内膜厚度每减少一毫米是否会导致妊娠率和活产率降低？临床妊娠率和活产率随着新鲜IVF-ET中子宫内膜厚度降低至8 mm以下和冻融胚胎移植（ET）周期中子宫内膜厚度降低至7 mm以下而下降。以前的研究是异质性的，并且在子宫内膜厚度对IVF结局的影响方面显示了相互矛盾的结果。大多数研究不包括许多子宫内膜厚度低于6 mm的患者，并且很少有冻融ET周期的研究。本研究是对CARTR-BORN数据库中2013年1月1日至2015年12月31日期间自体和供体新鲜和冻融IVF-ET周期的所有加拿大IVF新鲜和冻融ET周期的回顾性队列分析。在此时间范围内，共报告了24363个新鲜和20114个冻融IVF-ET周期。33家加拿大诊所自愿向CARTR-BORN数据库报告IVF和妊娠结局。分析新鲜IVF-ET和冻融周期子宫内膜厚度对妊娠、活产和妊娠丢失率的影响。在新鲜IVF-ET周期中，子宫内膜厚度小于8 mm时，临床妊娠率和活产率下降（P < 0.0001），妊娠丢失率增加（P = 0.01），子宫内膜厚度≥8、7 ~ 7.9、6 ~ 6.9和5 ~ 5.9mm时，活产率分别为33.7%、25.5%、24.6%和18.1%。在冻融ET周期中，临床妊娠率（P = 0.007）和活产率（P = 0.002）随着子宫内膜厚度低于7 mm的每毫米下降而下降，妊娠丢失率无显著差异。子宫内膜厚度≥8、7-7.9、6-6.9、5-5.9和4-4.9 mm的活产率分别为28.4、27.4、23.7、15和21.2%。子宫内膜厚度≥8 mm的可能性随着年龄的增长而降低（<35岁、35-39岁和≥40岁的女性分别为89.7%、87.8%和83.9%）（P < 0.0001）。这项研究只包括进行ET的周期，这可能会高估妊娠结局。由于与数据输入相关的数据不规则性，约8%的周期无法纳入分析。除年龄外的人口统计学数据不可用，但可能很重要，因为子宫内膜厚度较低可能与卵巢反应不良有关。虽然妊娠率和活产率随子宫内膜厚度的增加而降低，但即使子宫内膜厚度测量值较低，也能获得合理的结局。这些数据提供了有价值的指导医生和患者时，面临的决策有关的持续薄的子宫内膜。这项研究没有得到资助。作者没有任何利益冲突需要声明。N/A.
Does each millimeter decrease in endometrial thickness lead to lower pregnancy and live birth rates in fresh and frozen IVF cycles? Clinical pregnancy and live birth rates decline as the endometrial thickness decreases below 8 mm in fresh IVF-ET and below 7 mm in frozen–thaw embryo transfer (ET) cycles. Previous studies have been heterogenous and have shown conflicting results on the impact of endometrial thickness on IVF outcomes. Most studies do not include many patients with an endometrial thickness below 6 mm, and there are few studies of frozen–thaw ET cycles. This study is a retrospective cohort analysis of all Canadian IVF fresh and frozen–thaw ET cycles from the CARTR-BORN database for autologous and donor fresh and frozen–thaw IVF-ET cycles from 1 January 2013 to 31 December 2015. A total of 24 363 fresh and 20 114 frozen–thaw IVF-ET cycles were reported during this timeframe. 33 Canadians clinics participated in voluntary reporting of IVF and pregnancy outcomes to the CARTR-BORN database. The impact of endometrial thickness on pregnancy, live birth and pregnancy loss rates were analyzed for fresh IVF-ET and frozen–thaw cycles. In fresh IVF-ET cycles, clinical pregnancy and live birth rates decreased (P < 0.0001) and pregnancy loss rates increased (P = 0.01) with each millimeter decline in endometrial thickness below 8 mm. Live birth rates were 33.7, 25.5, 24.6 and 18.1% for endometrial thickness ≥8, 7–7.9, 6–6.9 and 5–5.9 mm, respectively. In frozen–thaw ET cycles, clinical pregnancy (P = 0.007) and live birth rates decreased (P = 0.002) with each millimeter decline in endometrial thickness below 7 mm, with no significant difference in pregnancy loss rates. Live birth rates were 28.4, 27.4, 23.7, 15 and 21.2% for endometrial thickness ≥8, 7–7.9, 6–6.9, 5–5.9 and 4–4.9 mm, respectively. The likelihood of achieving an endometrial thickness ≥8 mm decreased with age (89.7, 87.8 and 83.9% in women <35, 35–39 and ≥40, respectively) (P < 0.0001). This study only included cycles which proceeded to ET, which may overestimate pregnancy outcomes. Approximately 8% of cycles could not be included in the analysis due to data irregularity related to data entry. Demographic data aside from age were unavailable but may be important as lower endometrial thickness may be associated with poor ovarian response. Although pregnancy and live birth rates decrease with endometrial thickness, reasonable outcomes were obtained even with lower endometrial thickness measurements. These data provide valuable guidance for both physicians and patients when confronted with decisions related to a persistently thin endometrium. This study was not funded. The authors do not have any conflicts of interests to declare. N/A.
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DOI：
10.1186/1477-7827-12-96
发表时间：
2014-10-09
期刊：
Reproductive biology and endocrinology : RB&E
影响因子：
--
作者：
Wu Y;Gao X;Lu X;Xi J;Jiang S;Sun Y;Xi X
通讯作者：
Xi X
影响因子：
6.1
作者：
Kovacs, P;Matyas, S;Kaali, SG
通讯作者：
Kaali, SG
影响因子：
6.1
作者：
NOYES, N;LIU, HC;ROSENWAKS, Z
通讯作者：
ROSENWAKS, Z
影响因子：
6.7
作者：
El-Toukhy, Tarek;Coomarasamy, Arri;Braude, Peter
通讯作者：
Braude, Peter
影响因子：
3.1
作者：
Shufaro, Yoel;Simon, Alex;Fatum, Muhammad
通讯作者：
Fatum, Muhammad