The predictive value of volumetric blood flow parameters for outcome of hysteroscopic adhesiolysis and frozen embryo transfer after hysteroscopic adhesion resection

doi:10.11958/20253752

Abstract

Abstract:

Objective To investigate the relationship between three-dimensional power Doppler ultrasound volumetric blood flow parameters and pregnancy outcome of frozen-thawed embryo transfer (FET) after hysteroscopic adhesion resection (TCRA). Methods A total of 138 patients with TCRA who received FET were retrospectively included in this study, and according to their serum β-human chorionic gonadotropin (β-HCG) levels 12-14 days after transplantation, they were divided into the pregnancy group (76 cases) and the non-pregnancy group (62 cases). The volumetric blood flow parameters [vascular index (VI), flow index (FI), vascular-flow index (VFI)] and general clinical data were compared between the two groups of patients. Logistic regression analysis was used to analyze the influencing factors of pregnancy failure. The predictive value of the above blood flow parameters for pregnancy failure was evaluated by receiver operating characteristic (ROC) curves. Results In the non-pregnancy group, endometrial thickness on the day of transformation, the proportion of transferring two high-quality embryos, VI, FI and VFI were all lower than those in the pregnancy group (P<0.05). Multivariate Logistic regression analysis showed that transferring 0-1 high-quality embryos was an independent risk factor for FET pregnancy failure after TCRA, while high VI, FI, VFI and endometrial thickness on the day of transformation were protective factors (P<0.05). ROC curve analysis showed that the areas under the curve (AUC) for predicting pregnancy failure individually by VI, FI and VFI were 0.776, 0.752 and 0.861, respectively. The combined prediction of the three yielded an AUC of 0.923 (95%CI: 0.865-0.961), and its performance was significantly better than any single parameter alone (Z values were 3.892, 4.117 and 2.848, all P<0.01). Conclusion For patients undergoing FET after TCRA, elevated levels of VI, FI and VFI are independent associated factors for a reduced risk of pregnancy failure, and the combined testing of the three has high value in predicting pregnancy failure.

Key words: embryo transfer, pregnancy outcome, intrauterine adhesion, vascular index, flow index, vascular-flow index

CLC Number:

R715.2

Figures/Tables 5

References 25

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组别		n	年龄/岁		BMI/（kg/m²）			FSH/（U/L）		LH/（U/L）	E2/（pmol/L）		P/（nmol/L）		T/（nmol/L）
妊娠组		76	28.14±6.22		23.16±1.07			6.17±1.29		4.14±0.81	197.50±37.14		2.41±0.63		1.21±0.33
非妊娠组		62	28.53±4.13		23.15±1.05			6.20±1.39		4.17±0.83	196.95±36.18		2.45±0.63		1.20±0.30
t			0.420		0.059			0.129		0.222	0.087		0.395		0.271
组别	既往流产史						转化日子宫内膜厚度/mm		胚胎移植方案							胚胎冷冻保存时间/月
	既往流产史								（改良）自然周期			激素替代周期		降调后激素替代周期
	0次			1次		≥2次			（改良）自然周期			激素替代周期		降调后激素替代周期
妊娠组	22（28.95）			38（50.00）		16（21.05）	10.43±1.44		30（39.47）			10（13.16）		36（47.37）		9.14±2.05
非妊娠组	18（29.03）			33（53.23）		11（17.74）	8.83±1.59		26（41.94）			8（12.90）		28（45.16）		9.17±1.32
χ²或t	0.260						6.184^＊＊		0.089							0.113
组别			移植胚胎阶段					移植优质胚胎数				术前宫腔粘连程度
组别			D3			D5		0~1枚			2枚	轻度			中度	重度
妊娠组			24（31.58）			52（68.42）		27（35.53）			49（64.47）	15（19.74）			50（65.79）	11（14.47）
非妊娠组			19（30.65）			43（69.35）		37（59.68）			25（40.32）	12（19.35）			41（66.13）	9（14.52）
χ²			0.014					8.008^＊＊				0.003

组别		n	年龄/岁		BMI/（kg/m²）			FSH/（U/L）		LH/（U/L）	E2/（pmol/L）		P/（nmol/L）		T/（nmol/L）
妊娠组		76	28.14±6.22		23.16±1.07			6.17±1.29		4.14±0.81	197.50±37.14		2.41±0.63		1.21±0.33
非妊娠组		62	28.53±4.13		23.15±1.05			6.20±1.39		4.17±0.83	196.95±36.18		2.45±0.63		1.20±0.30
t			0.420		0.059			0.129		0.222	0.087		0.395		0.271
组别	既往流产史						转化日子宫内膜厚度/mm		胚胎移植方案							胚胎冷冻保存时间/月
	既往流产史								（改良）自然周期			激素替代周期		降调后激素替代周期
	0次			1次		≥2次			（改良）自然周期			激素替代周期		降调后激素替代周期
妊娠组	22（28.95）			38（50.00）		16（21.05）	10.43±1.44		30（39.47）			10（13.16）		36（47.37）		9.14±2.05
非妊娠组	18（29.03）			33（53.23）		11（17.74）	8.83±1.59		26（41.94）			8（12.90）		28（45.16）		9.17±1.32
χ²或t	0.260						6.184^＊＊		0.089							0.113
组别			移植胚胎阶段					移植优质胚胎数				术前宫腔粘连程度
组别			D3			D5		0~1枚			2枚	轻度			中度	重度
妊娠组			24（31.58）			52（68.42）		27（35.53）			49（64.47）	15（19.74）			50（65.79）	11（14.47）
非妊娠组			19（30.65）			43（69.35）		37（59.68）			25（40.32）	12（19.35）			41（66.13）	9（14.52）
χ²			0.014					8.008^＊＊				0.003

组别	n	VI/%	FI	VFI
妊娠组	76	2.01±0.29	22.16±3.25	0.71±0.12
非妊娠组	62	1.76±0.24	19.29±3.26	0.52±0.12
t		5.540^＊＊	5.198^＊＊	9.164^＊＊

组别	n	VI/%	FI	VFI
妊娠组	76	2.01±0.29	22.16±3.25	0.71±0.12
非妊娠组	62	1.76±0.24	19.29±3.26	0.52±0.12
t		5.540^＊＊	5.198^＊＊	9.164^＊＊

变量	β	SE	Wald χ²	P	OR	OR（95%CI）
VI	-2.872	1.036	7.680	0.006	0.057	0.007~0.431
FI	-0.245	0.090	7.440	0.006	0.782	0.656~0.933
VFI	-0.116	0.026	19.299	<0.001	0.891	0.846~0.938
转化日子宫内膜厚度	-0.610	0.189	10.464	0.001	0.543	0.375~0.786
移植优质胚胎数	1.187	0.588	4.082	0.043	3.278	1.038~10.367
常数项	22.662	4.135	30.031	<0.001	6.96×10⁹	-