The Effect Of Dydrogesterone Treatment On The Pregnancy Outcome Of Frozen-thawed Embryo Transfer In Patients With Chronic Endometritis And Adverse Pregnancy Outcome

Objective:To explore the therapeutic effect of dydrogesterone combined with antibiotics in the treatment of chronic endometritis and its influence on the outcome of frozen-thawed embryo transfer in patients with adverse pregnancy outcomes.Methods:A total of 82 patients with adverse pregnancy outcomes who underwent frozen-thawed embryo transfer and assisted pregnancy with chronic endometritis at the Assisted Reproductive Center of Sichuan Provincial People’s Hospital from December2021 to October 2022 were included as the study subjects.They were randomly divided according to the treatment methods of chronic endometritis before retransplantation:experimental group(n=40): dydrogesterone+moxifloxacin treatment group;Control group(n=42): moxifloxacin only treatment group;After standardized drug treatment,all patients were taken intimal biopsy again 7-9 days after the LH peak of the next menstrual cycle and immunohistochemistry was performed.According to whether CD38 and CD138 negative cells were found,they were further divided into cure group and incomplete cure group.The therapeutic effects of chronic endometritis in the experimental group and the control group were compared.The differences of HCG positive rate,biochemical pregnancy rate,clinical pregnancy rate,embryo implantation rate and abortion rate among different groups were observed and compared.Results:1.After treatment,the cure rate of chronic endometritis was 80% in the experimental group and 73.8% in the control group.There was no statistical difference between the two groups(P=0.507).2.The abortion rate of the experimental group was significantly lower than that of the control group(0% vs 25%,P=0.014).The HCG positive rate,clinical pregnancy rate and embryo implantation rate of the experimental group were higher than those of the control group,and the biochemical pregnancy rate was lower than that of the control group,but there was no statistical difference(P>0.05).3.Under the condition that chronic endometritis is cured(CD38-,CD138-),the HCG positive rate,clinical pregnancy rate and embryo implantation rate in the experimental group are better than those in the control group,and the abortion rate and biochemical pregnancy rate are lower than those in the control group,but there is no statistical difference.(P>0.05).4.When chronic endometritis is incomplete cured(CD38+or/and CD138+),the abortion rate in the experimental group is much lower than that in the control group(0%vs 100%,P=0.008).The HCG positive rate,clinical pregnancy rate and embryo implantation rate of the experimental group were higher than those of the control group,and the biochemical pregnancy rate was lower than that of the control group,but there was no statistical difference(P>0.05).5.In the experimental group,the biochemical pregnancy rate of the cured group was lower than that of the incomplete cure group(9.4% vs 37.5%,P=0.046).The clinical pregnancy rate and embryo implantation rate of the cured group were better than those of the incomplete cure group,but there was no statistical difference(P>0.05).There was no statistical difference between the HCG positive rate and the abortion rate between the cured group and the incomplete cure group(P>0.05).6.In the control group,the biochemical pregnancy rate and abortion rate in the cure group were lower than those in the control group(9.7% vs 36.4%,P=0.041);(6.3%vs 100%,P=0.000).The clinical pregnancy rate and embryo implantation rate of the cured group were better than those of the incomplete cure group,with no statistical difference(P>0.05).There was no significant difference in the positive rate of HCG between the cured group and the untreated group(P>0.05).Conclusion:Although there is no significant difference between the therapeutic effect of dydrogesterone combined with antibiotics in the treatment of chronic endometritis and that of antibiotics alone,the risk of miscarriage in patients with chronic endometritis treated with dydrogesterone combined with antibiotics can be reduced.In addition,chronic endometritis can reduce the risk of adverse pregnancy outcomes in patients with adverse pregnancy outcomes after being cured by drugs.