Effect of ultrasound-guided individualized treatment regimen on outcome of frozen-thawed embryo transfer in patients with adenomyosis
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摘要:目的
探讨超声引导下个体化治疗方案对子宫腺肌症患者冻融胚胎移植结局的影响。
方法回顾性收集80例子宫腺肌症患者的临床资料, 根据治疗方案的不同将患者分为观察组和对照组，每组40例。观察组采用超声引导下个体化治疗方案，对照组采用常规治疗方案。比较2组患者的子宫内膜厚度、血清激素水平、胚胎种植率、临床妊娠率、早期流产率和活产率，并绘制受试者工作特征(ROC)曲线评估相关指标对胚胎移植结局的预测价值。
结果胚胎移植日，观察组子宫内膜厚度大于对照组，差异有统计学意义(P < 0.05); 胚胎移植日，观察组血清雌二醇、孕酮水平均高于对照组，差异有统计学意义(P < 0.05); 胚胎移植后，观察组的胚胎种植率、临床妊娠率和活产率均高于对照组，早期流产率则低于对照组，差异有统计学意义(P < 0.05)。ROC曲线分析结果显示，子宫内膜厚度、血清雌二醇水平和血清孕酮水平联合预测胚胎移植成功的曲线下面积(AUC)为0.88, 大于三者单独预测的AUC(0.64、0.69和0.68)。
结论超声引导下个体化治疗方案能够显著增加子宫内膜厚度，改善子宫内环境，调节激素水平，进而提高胚胎种植率、临床妊娠率和活产率，并降低早期流产率，为子宫腺肌症患者成功生育提供了重要保障。
Abstract:ObjectiveTo explore the impact of ultrasound-guided individualized treatment regimens on the outcomes of frozen-thawed embryo transfer (FET) in patients with adenomyosis.
MethodsA retrospective analysis was conducted on the clinical data of 80 patients with adenomyosis. Based on treatment regimen, the patients were divided into observation group and control group, with 40 patients in each group. The observation group received ultrasound-guided individualized treatment, while the control group received conventional treatment. The endometrial thickness, serum hormone levels, embryo implantation rate, clinical pregnancy rate, early miscarriage rate, and live birth rate were compared between the two groups. Receiver operating characteristic (ROC) curves were constructed to assess the predictive value of relevant indicators for embryo transfer outcomes.
ResultsOn the day of embryo transfer, the endometrial thickness in the observation group was greater than that in the control group (P < 0.05). On the same day, the serum estradiol and progesterone levels in the observation group were higher than those in the control group (P < 0.05). After embryo transfer, the observation group exhibited higher embryo implantation rate, clinical pregnancy rate, and live birth rate, as well as a lower early miscarriage rate compared with the control group (P < 0.05). The results of ROC curve analysis revealed that the area under the curve (AUC) for the combined prediction of embryo transfer success using endometrial thickness, serum estradiol level, and serum progesterone level was 0.88, which was greater than that of individual predictors (0.64, 0.69, and 0.68).
ConclusionUltrasound-guided individualized treatment regimens can significantly optimize endometrial thickness, improve the intrauterine environment, and regulate hormone levels, thereby enhancing the embryo implantation rate, clinical pregnancy rate and live birth rate, reducing the early miscarriage rate, and providing an important safeguard for successful fertility in patients with adenomyosis.
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Keywords:
- adenomyosis /
- ultrasound-guided /
- individualized treatment /
- embryo transfer /
- estradiol /
- endometrial thickness
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表 1 2组患者一般资料比较(x±s)[n(%)]
指标 观察组(n=40) 对照组(n=40) 年龄/岁 34.5±4.2 33.8±4.5 病程/年 6.2±2.1 5.9±2.3 体质量指数/(kg/m2) 23.4±2.8 22.9±3.1 初次月经年龄/岁 12.8±1.3 12.6±1.4 平均胚胎移植次数/次 1.8±0.7 1.9±0.6 合并症 3(7.5) 4(10.0) 
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表 2 2组患者不同时点子宫内膜厚度比较(x±s)
mm 时点 对照组(n=40) 观察组(n=40) 激素替代治疗第1天 5.2±1.1 5.1±1.0 激素替代治疗第7天 7.5±1.3 7.8±1.2 胚胎移植日 8.9±1.6 9.6±1.5* 与对照组比较, * P < 0.05。
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表 3 2组患者不同时点血清激素水平比较(x±s)
指标 时点 对照组(n=40) 观察组(n=40) 雌二醇/(pg/mL) 激素替代治疗第1天 259.9±13.6 261.8±15.2 激素替代治疗第7天 304.5±18.6 313.6±17.6 胚胎移植日 426.8±20.5 479.6±24.6* 孕酮/(ng/mL) 激素替代治疗第1天 0.6±0.2 0.5±0.2 激素替代治疗第7天 0.7±0.3 0.8±0.3 胚胎移植日 0.9±0.3 1.2±0.4* 与对照组比较, * P < 0.05。
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表 4 2组不同时点胚胎种植成功情况比较[n(%)]
时点 对照组(n=40) 观察组(n=40) 胚胎移植前 18(45.0) 20(50.0) 胚胎移植后 24(60.0) 32(80.0)* 与对照组比较, * P < 0.05。
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表 5 2组不同时点临床妊娠情况比较[n(%)]
时点 对照组(n=40) 观察组(n=40) 胚胎移植前 6(15.0) 8(20.0) 胚胎移植后 20(50.0) 28(70.0)* 与对照组比较, * P < 0.05。
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