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Effect of endometrial thickness on the risk of ectopic pregnancy for frozen embryo transfer

生殖与发育医学(英文) 2024年第2期8卷 75-81页

作者： Huang Li-Juan Zheng Qu Wang Xue-Jiao Zhong Zhao-Hui Fu Li-Juan Lv Xing-Yu Geng Li-Hong Tang Xiao-Jun Ding Yu-Bin Wan Qi Department of Obstetrics and Gynecology Women and Children’s Hospital of Chongqing Medical University Chongqing China School of Public Health Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China Chongqing China The Reproductive Center Chengdu Xinan Gynecology Hospital Chengdu China School of Public Health Research Center for Medical and Social Development Chongqing Medical University Chongqing China Department of Pharmacology Academician Workstation Changsha Medical University Changsha China Department of Obstetrics and Gynecology West China Second Hospital Sichuan University Chengdu China

Objective: Few studies have explored the suitability of endometrial thickness (EMT) as a predictor of ectopic pregnancy (EP) in frozen embryo transfer (FET) cycles. Our study aimed to investigate the association between EMT and EP and explore the cutoff value of EMT to predict EP.Methods: This retrospective cohort study included women aged 20-45 years undergoing FET between March 2015 and September 2021. The primary outcomes and measured variables were EP and EMT, respectively. The threshold effect of EMT on EP was calculated based on a constructed smooth curve fitting. The patients were divided into two groups based on the threshold for comparison. A subgroup analysis was conducted to examine whether the relationship between EMT and EP remained consistent across the different subgroups. Additionally, a generalized linear model was used to analyze the interactions between the treatment factors and EMT in EP.Results: In total, 27,549 FET cycles were included, with 27,086 intrauterine and 463 ectopic pregnancies. The risk of EP in the EMT ≤8.7 mm group was 3.36 times higher than that in the EMT >8.7 mm group (odds ratio [OR]: 3.36, 95% confidence interval [CI]: 2.57-4.05). Subgroup analysis further indicated that a thin EMT was a risk factor for EP, independent of other risks. We also noted that diminished ovarian reserve, tubal factor infertility, transfer of two embryos, or transfer of cleavage-stage embryos may further enhance the risk of EP in patients with thin endometrium.Conclusions: thin endometrium was associated with an increased risk of EP. Patients with EMT less than 8.7 mm need close medical observation and management after embryo transfer. In addition, diminished ovarian reserve, tubal factor infertility, transfer of two embryos, or transfer of cleavage-stage embryos may significantly enhance the effect of a thin endometrium on the risk of EP.

关键词： Endometrial thickness thin endometrium Ectopic pregnancy FET cycle Risk factors

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Clinical observation of endometrial prescription combined with TAM on FET of thin endometrial patients with kidney deficiency and blood stasis

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Clinical Research Communications 2024年第2期7卷 18-22页

作者： Wen-Ming Cao Nan Jiang Mei-Hua Wu Xiao-Lei Song Na Yu Shu-Ling Zhang Kui-Mei Zhang Gynecology department Shenzhen Hospital of Integrated Traditional Chinese and Western MedicineShenzhen 518104China Gynecology department Shandong Maternal and Child Health HospitalJinan 2500013China Gynecology department Shandong Changle People’s HospitalWeifang 262400China.

Objective:To explore the best endometrial preparation scheme of freeze-thawed embryo transfer(FET)for patients with thin endometrium with kidney deficiency and blood stasis by comparing the clinical outcomes of three endometrial preparation schemes of estradiol valerate tablets Hormone Replacement(HRT),Tamoxifen(TAM)and Endometrial Prescription combined with TAM(EP-TAM group).Method:Retrospective analysis of 318 patients with thin endometrium with kidney deficiency and blood stasis who underwent FET in Changle People's Hospital of Shandong Province,Shandong Maternal and Child Health Hospital,and Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine from September 2018 to March 2023,including 101 patients in HRT group(estradiol valerate tablets);108 patients in TAM group;109 patients in EP-TAM group.The cycle cancellation rate,intimal thickness,clinical pregnancy rate,embryo implantation rate,early abortion rate and ectopic pregnancy rate were compared among the three groups.Result:Cycle cancellation rates of TAM group and EP-TAM group were significantly lower than HRT group(8.3%,9.2%vs 17.8%,Pthin endometrium underwent FET can try endometrium Prescription combined with TAM(EP-TAM)to prepare the endometrium.

关键词： endometrium prescription estradiol valerate tablets tamoxifen hormone replacement thin endometrium freeze-thawed embryo transfer

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Factors Associated with Effectiveness of Treatment and Reproductive Outcomes in Patients with thin endometrium Undergoing Estrogen Treatment

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Chinese Medical Journal 2015年第23期128卷 3173-3177页

作者： Si-Miao Liu Yuan-Zheng Zhou Han-Bi Wang Zheng-Yi Sun Jing-Ran Zhen Keng Shen Cheng-Yan Deng Jing-He Lang Department of Obstetrics and Gynecology Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100730 China

Background： thin endometrium is associated with poor reproductive outcomes; estrogen treatment can increase endomctrial thickness （EMT）. The aim of this retrospective cohort study was to investigate the factors influencing the effectiveness of estrogen treatment and reproductive outcomes after the treatment in patients with thin endometrium. Methods： Relevant clinical data of 101 patients with thin endometrium who had undergone estrogen treatment were collected. Possible factors influencing the effectiveness of treatment were analyzed retrospectively by logistic regression analysis. Eighty-seven infertile women without thin endometrium who had undergone assisted reproduction served as controls. The cases and controls were matched for age, assisted reproduction method, and number of embryos transferred. Reproductive outcomes of study and control groups were compared using Student＇s t-test and the Chi-square test. Results： At the end of estrogen treatment, EMT was ≥8 mm in 93/101 patients （92.1%）. Effectiveness of treatment was significantly associated with maximal pretreatment EMT （P = 0.017） and treatment duration （P = 0.004）. The outcomes of assisted reproduction were similar in patients whose treatment was successful in increasing EMT to ≥8 mm and the control group. The rate of clinical pregnancy in patients was associated with the number of good-quality embryos transferred in both fresh （P = 0.005） and frozen-thawed （P = 0.000） embryo transfer cycles. Conclusions： thinner EMT before estrogen treatment requires longer treatment duration and predicts poorer treatment outcomes. The effectiveness of treatment depends on the duration of estrogen administration. Assisted reproductive outcomes of patients whose treatment is successful （i.e., achieves an EMT ≥8 mm） are similar to those of controls. The quality of embryos transferred is an important predictor of assisted reproductive outcomes in patients treated successfully with exogenous estrogen.

关键词： Assisted Reproduction Endometrial Thickness Estrogen thin endometrium

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A Discussion on the Constitution Factors of thin endometrium Based on the Theory of Qi and Blood

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Journal of Clinical and Nursing Research 2022年第4期6卷 128-133页

作者： Yuchun Qian Rongfeng Pu Jing Cai Shaanxi University of Chinese Medicine Xianyang 712000Shaanxi ProvinceChina Affiliated Hospital of Shaanxi University of Chinese Medicine Xianyang 712000Shaanxi ProvinceChina

thin endometrium has been proven to be a key contributing factor leading to infertility and poor pregnancy outcomes.Increasing the thickness and capacity of thin endometrium seems to be one of the challenging issues in reproductive medicine.The states of qi and blood are closely related to uterine blood circulation.Constitution is regarded as an important basis for determining the incidence as well as distinguishing,preventing,and treating diseases in traditional Chinese medicine.Based on the theory of qi and blood,this paper discusses the constitution factors of thin endometrium and puts forward the prospect of using big data tools to investigate the correlation between qi-blood imbalance constitution and the incidence of thin endometrium,so as to explore new approaches for the prevention and treatment of thin endometrium by regulating qi and blood as well as improving the constitution condition.

关键词： Theory of qi and blood Constitution thin endometrium Infertility

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Influence of Growth Hormone Supplementation in Patients with thin endometrium Undergoing Frozen Embryo Transfer

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Reproductive and Developmental Medicine 2019年第1期3卷 49-53页

作者： Jun-Yi Yang He Li Nan Lu Lu Li Xiao-Xi Sun Shanghai Ji Ai Genetics and IVF Institute Obstetrics and Gynecology Hospital of Fudan UniversityShanghai 200011China Key Laboratory of Female Reproductive Endocrine Related Diseases Obstetrics and Gynecology Hospital of Fudan UniversityShanghai 200011China

Objective:To evaluate the effect of recombinant human growth hormone(rhGH)supplementation during hormone-replacement therapy and frozen-thawed embryo transfer(FET)in patients with thin endometrium.Methods:A retrospective research was conducted on 225 patients,who underwent artificial cycle FET in Shanghai,China,between January 2016 and November 2017.Data from 245 FET cycles were analyzed,of which 184 cycles received rhGH(GH group)and 61 did not(control group).Results:Clinical pregnancy and implantation rates were significantly higher in the GH group than those in the control group(64.7%vs.49.2%,P=0.032;44.8%vs.32.8%,P=0.019,respectively).After logistic regression analysis,rhGH was considered the only significant variable that influenced clinical pregnancy rate,increasing it by 1.89-fold.On the other hand,the presence of rhGH did not seem to affect the early pregnancy loss.Conclusions:Our results indicated that simultaneous addition of rhGH could improve clinical outcomes of FET in patients with thin endometrium,particularly in patients between 30 and 34 years of age.

关键词： Endometrial Receptivity Frozen-Thawed Embryo Transfer Growth Hormone thin endometrium

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Collagen-binding basic fibroblast growth factor improves functional remodeling of scarred endometrium in uterine infertile women: a pilot study

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Science China(Life Sciences) 2019年第12期62卷 1617-1629页

作者： Peipei Jiang Xiaoqiu Tang Huiyan Wang Chenyan Dai Jing Su Hui Zhu Minmin Song Jingyu Liu Ziqing Nan Tong Ru Yaling Li Jingmei Wang Jun Yang Bing Chen Jianwu Dai Yali Hu Department of Obstetrics and Gynecology The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolNanjing 210008China Center for Reproductive Medicine Department of Obstetrics and GynecologyThe Affiliated Drum Tower Hospital of Nanjing University Medical SchoolNanjing 210008China Nanjing Drum Tower Hospital Chinese Academy of Medical Science&Peking Union Medical CollageNanjing 210008China Department of Pathology The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolNanjing 210008China Institute of Genetics and Developmental Biology Chinese Academy of SciencesBeijing 100190China

Intrauterine adhesion(IUA) is a common cause of uterine infertility and one of the most severe clinical features is endometrial fibrosis namely endometrial scarring for which there are few cures currently. Blocked angiogenesis is the main pathological change in the scarred endometrium. The fibroblast growth factor 2(b FGF), a member of FGF family, is usually applied to promote healing of refractory ulcer and contributes to angiogenesis of tissues. In this study, the sustained-release system of b FGF100 μg was administrated around scarred endometrium guiding by ultrasound every 4 weeks in 18 patients(2–4 times). Results showed that after treatment, the menstrual blood volume, endometrial thickness and the scarred endometrial area were improved.Histological study showed blood vessel density increased obviously. Three patients(3/18) achieved pregnancy over 20 gestational weeks. Therefore, administrating the b FGF surrounding scarred endometrium may provide a new therapeutic approach for the patients with endometrial fibrosis.

关键词： intrauterine adhesion CBD-bFGF endometrial scarring uterine infertility thin endometrium endometrial reconstruction

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Effect of intrauterine perfusion of granular leukocyte-colony stimulating factor on the outcome of frozen embryo transfer

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World Journal of Clinical Cases 2021年第30期9卷 9038-9049页

作者： Ying-Chun Zhu Yan-Xin Sun Xiao-Yue Shen Yue Jiang Jing-Yu Liu Reproductive Medicine Center The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolNanjing 210008Jiangsu ProvinceChina

BACKGROUND Treatment of thin endometrium with granular leukocyte-colony stimulating factor(G-CSF)remains controversial.AIM To investigate the effect of G-CSF on the outcome of frozen embryo transfer in patients with thin endometrium.METHODS A retrospective propensity score matching(PSM)study was performed to assess patients administered frozen embryo transfer at the Reproductive Medicine Center of the Affiliated Drum Tower Hospital of Nanjing University Medical School,in 2012-2018.The patients were divided into G-CSF intrauterine perfusion(G-CSF)and non-G-CSF groups,and clinical pregnancy,implantation,ectopic pregnancy,and early abortion rates between the two groups were compared.RESULTS Before PSM,372 cycles were enrolled,including 242 and 130 cycles in the G-CSF and non-G-CSF groups,respectively.Age(34.23±5.76 vs 32.99±5.59 years;P=0.047)and the blastula/cleavage stage embryo ratio(0.68 vs 0.37;P=0.011)were significantly elevated in the G-CSF group compared with the non-G-CSF group;however,clinical pregnancy(46.28%vs 51.54%;P=0.371)and embryo implantation(35.21%vs 35.65%;P=0.910)rates were similar in both groups.After PSM by age and blastula/cleavage stage embryo ratio,244 cycles were included(122 cases each in the G-CSF and non-G-CSF groups).The clinical pregnancy(50.82%vs 48.36%;P=0.701)and embryo implantation(37.38%vs 34.11%;P=0.480)remained similar in both groups.CONCLUSION Intrauterine infusion of G-CSF does not improve the clinical outcome of frozen embryo transfer in patients with thin endometrium.

关键词： thin endometrium Granular leukocyte-colony stimulating factor Intrauterine perfusion Frozen embryo transfer

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