Analysis of the risk factors and treatment for repeated implantation failure: OPtimization of Thyroid function, IMmunity, and Uterine Milieu (OPTIMUM) treatment strategy
Analysis of the risk factors and treatment for repeated implantation failure: OPtimization of Thyroid function, IMmunity, and Uterine Milieu (OPTIMUM) treatment strategy
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DOI：
10.1111/aji.13376
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发表时间：
2020-11-27
影响因子：
3.6
通讯作者：
Sugiyama, Rikikazu
中科院分区：
文献类型：
--
作者：
Kuroda, Keiji;Matsumura, Yuko;Sugiyama, Rikikazu
反复着床失败（RIF）患者在优化甲状腺功能、免疫和子宫环境（OPTIMUM）治疗策略后的妊娠结局如何？研究方法：在2017年4月至2018年8月期间，有超过3个胚胎移植（ET）周期后有RIF史的不孕妇女接受了植入试验，包括宫腔镜检查、子宫内膜活检（CD138免疫染色和细菌培养）、血清25-羟基维生素D-3、干扰素- γ产生辅助性T （Th1）细胞、il -4产生辅助性T （Th2）细胞、促甲状腺激素、甲状腺过氧化物酶抗体和血栓形成筛查。我们用抗生素治疗慢性子宫内膜炎，用维生素D和/或他克莫司摄入异常高的Th1/Th2细胞比例，用左甲状腺素治疗明显/亚临床甲状腺功能减退，用小剂量阿司匹林治疗血栓形成。在116名RIF妇女中，88名有133个ET周期的妇女是从基于怀孕结果的问卷调查中招募的。还招募了59名未采用最佳治疗策略的连续RIF患者作为对照。结果116例经最佳治疗方案的RIF患者年龄38.3 +/- 3.8岁，有5（3-19）个ET周期的着床失败史。植入试验发现75例（64.7%）女性宫内环境受损，56例（48.3%）女性Th1/Th2细胞比例异常升高，33例（28.4%）女性甲状腺异常。在两个ET周期内，年龄< 40岁和>= 40岁患者的累计持续妊娠率（包括自然妊娠）分别为72.7%和45.5%。优化组妊娠结局明显高于对照组。结论优化的治疗策略改善了RIF患者的妊娠结局。
Problem What are the pregnancy outcomes after the OPtimization of Thyroid function, Immunity, and Uterine Milieu (OPTIMUM) treatment strategy in patients with repeated implantation failure (RIF)?Method of study Infertile women with a history of RIF after more than three embryo transfer (ET) cycles underwent implantation testing, including a hysteroscopy, endometrial biopsy for CD138 immunostaining and bacterial culture, and serum 25-hydroxyvitamin D-3, interferon-gamma-producing helper T (Th1) cell, IL-4-producing helper T (Th2) cell, thyroid-stimulating hormone, thyroid peroxidase antibody, and thrombophilia screening between April 2017 and August 2018. We treated chronic endometritis with antibiotics, aberrant high Th1/Th2 cell ratios with vitamin D and/or tacrolimus intake, overt/subclinical hypothyroidism with levothyroxine, and thrombophilia with low-dose aspirin. Of the 116 RIF women, 88 women with 133 ET cycles were recruited from a questionnaire-based survey regarding pregnancy outcomes. Fifty-nine consecutive RIF patients without the OPTIMUM treatment strategy were also recruited as a control.Results The 116 women with RIF after the OPTIMUM treatment strategy were 38.3 +/- 3.8 years old and had an implantation failure history over 5 (3-19) ET cycles. Implantation testing identified impaired intrauterine circumstances in 75 women (64.7%), an aberrant elevated Th1/Th2 cell ratio in 56 women (48.3%), and thyroid abnormalities in 33 women (28.4%). Cumulative ongoing pregnancy rates including spontaneous pregnancy in the patients aged < 40 and >= 40 years were 72.7% and 45.5% within two ET cycles, respectively. The pregnancy outcomes in the OPTIMUM group were significantly higher than those in the control.Conclusions The OPTIMUM treatment strategy improved pregnancy outcomes in patients with RIF.