Endometrial Thickness Dynamics and Morphologic Characteristics During Pituitary Downregulation With Antagonists in Assisted Reproductive Technology Cycles
Endometrial Thickness Dynamics and Morphologic Characteristics During Pituitary Downregulation With Antagonists in Assisted Reproductive Technology Cycles
复制标题
DOI：
10.7863/jum.2008.27.11.1591
复制
发表时间：
2008-11-01
影响因子：
2.3
通讯作者：
Puscheck, Elizabeth E.
中科院分区：
文献类型：
--
作者：
Detti, Laura;Yelian, Frank D.;Puscheck, Elizabeth E.
目标。本研究的目的是评估在体外受精(IVF)/胞浆内单精子注射（ICSI）周期中促性腺激素释放激素（GnRH）拮抗剂垂体下调期间子宫内膜条纹厚度的动态变化是否与着床和妊娠结局有关。方法。本回顾性队列研究评估了115个常规IVF/ICSI周期。所有患者均使用促性腺激素和GnRH拮抗剂醋酸甘尼瑞克刺激卵巢。从GnRH拮抗剂初始给药当天到人绒毛膜促性腺激素（hCG）触发当天，每天经阴道测量子宫内膜条纹，然后在胚胎移植当天经腹部测量子宫内膜厚度变化。我们创建了5类（0-4）子宫内膜厚度变化，考虑到每天1.5 mm的显著变化。我们的目的是预测子宫内膜厚度动态或形态特征是否与卵巢刺激的持续时间、使用ganirelix的持续时间或卵巢刺激期间雌二醇水平有关，以及它们是否会影响着床率和妊娠率。结果。卵巢刺激的持续时间、使用ganirelix的持续时间、雌二醇水平（以曲线下面积表示）与子宫内膜厚度动态或形态特征之间没有关系。尽管与GnRH拮抗剂刺激开始时相比，在hCG触发当天37%的周期中子宫内膜厚度更薄，但子宫内膜动力学与妊娠结局之间没有相关性。相反，三层子宫内膜形态与妊娠试验结果阳性、着床成功和妊娠持续呈正相关（P < 0.05）。结论。尽管在近50%的病例中，子宫内膜厚度净减少，但子宫内膜动力学与妊娠结局无关。相反，胚胎移植当天的三层子宫内膜形态模式与妊娠结局呈正相关。
Objective. The purpose of this study was to evaluate whether the dynamics of endometrial stripe thickness during gonadotropin-releasing hormone (GnRH) antagonist pituitary downregulation in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles are related to implantation and pregnancy outcomes. Methods. This retrospective cohort study evaluated 115 conventional IVF/ICSI cycles. All patients underwent ovarian stimulation with gonadotropins and the GnRH antagonist ganirelix acetate. The endometrial stripe was measured transvaginally daily from the day of initial GnRH antagonist administration to the day of the human chorionic gonadotropin (hCG) trigger and then transabdominally on the day of embryo transfer We created 5 categories (0-4) of endometrial thickness variation, considering significant a daily variation of 1.5 mm. Our aim was to predict whether the endometrial thickness dynamics or morphologic characteristics were related to the duration of ovarian stimulation, duration of ganirelix use, or estradiol levels during ovarian stimulation and whether they would influence implantation and pregnancy rates. Results. No relationship was found between the duration of ovarian stimulation, duration of ganirelix use, and estradiol level (expressed as the area under the curve), and endometrial thickness dynamics or morphologic characteristics. Despite a thinner endometrial thickness in 37% of the cycles on the day of the hCG trigger compared with the beginning of GnRH antagonist stimulation, there was no correlation between endometrial dynamics and pregnancy outcomes. There was, instead, a positive relationship between a trilaminar endometrial morphologic pattern with a positive pregnancy test result, successful implantation, and ongoing pregnancy (P < .05). Conclusions. Despite a net decrease in thickness in almost 50% of cases, endometrial dynamics did not correlate with pregnancy outcomes. Conversely, a trilaminar endometrial morphologic pattern on the day of embryo transfer was positively related to pregnancy outcomes.