| Objective: To formulate an ultrasonographic criteria for endometrial receptivity on IVF transplantation days,and grade the infertile patients' endometrial receptivity by the established scoring system on the day of transplantation.Combine the post-transplant pregnancy outcomes,to evaluate the efficacy of this criteria in terms of evaluating endometrial receptivity under ultrasound monitoring on embryo transfer day,in order to direct clinical works.Methods: A total of 938 patients were retrospectively analyzed in terms of receiving IVF assisted pregnancy and embryo transplantation from September 2016 to April 2018,such patients were from the Reproductive Medicine Center of North theater General Hospital of the 202 Theater of The Chinese People's Liberation Army.The case information of the enrolled patients was reviewed,and the endometrial receptivity on transplantation day was scored according to the established ultrasonographic scoring system,which full score is 22 points.Based on the distribution of pregnancy rate,embryo implantation rate and pregnancy score,the patients were divided into three groups with 13 points and 17 points as thresholds,letters A,B and C were used.Patients with less than 13 points were in group A,14-17 points in group B,and 18-22 points in group C.The differences of clinical pregnancy rate and embryo implantation rate,as well as the differences of ultrasound monitoring indexes between the three groups were compared.Results:1.Comparison of general data : Age,body mass index,infertility type,and infertility years showed no statistical significance between the three groups(P > 0.05).2.Comparison of clinical pregnancy outcome scores: The average score of the clinical pregnancy group fluctuated around 17 points in the fresh embryo transfer cycle,freeze-thaw embryo transfer cycle,blastocyst transfer cycle and cleavage embryo transfer cycle,which was higher than that of the non-pregnancy group,and the difference was statistically significant(P?0.05).3.Comparison of embryo implantation rates: The implantation rates of embryos in group A,B and C were 0.30±0.27,0.46±0.42,and 0.47±0.42.The differences between group B and C and group A were statistically significant(P?0.05).The implantation rates of embryos in the cleavage stage of group A,B and C were 0.26±0.17,0.36±0.25 and 0.43±0.38.The implantation rates of blastocysts in group A,B and C were0.33±0.24,0.52±0.44 and 0.54±0.43.In the same group,the embryo implantation rate of blastocysts was higher than that of cleavage stage,and the difference was statistically significant(P?0.05).4.Comparison of clinical pregnancy rates: The clinical pregnancy rates of group A,B and C were 39.66%,61.87% and 65.56%,the difference was statistically significant(P?0.05).The pregnancy rates of embryos in the cleavage stage were 34.78%,55.10%and 63.06%.The embryo clinical pregnancy rates of blastocysts were 42.85%,66.92%and 67.34.In the same group,the difference of clinical pregnancy rate between the cleavage period and that of the blastocyst showed no statistical significance(P?0.05).5.Comparison of endometrial receptivity indexes under ultrasound monitoring among groups A,B and C:(1)The endometrial thickness was 0.83±0.27 cm,0.97±0.22 cm,and 1.06±0.15 cm,the difference was statistically significant(P?0.05).(2)The endometrial volume was 1.77±0.42 ml,2.29±1.35 ml,and 2.32±1.10 ml,respectively,with statistically significant differences(P?0.05).(3)The endometrial blood flow counts were 5.93±1.51,7.01±1.39 and 8.25±1.32,with statistically significant differences(P?0.05).(4)The proportion of type A endometrium morphology was 15.52%,15.90% and34.20%,the difference was statistically significant(P?0.05).(5)The proportion of endometrium type I blood flow was 18.97%,3.49% and0.48%%,the difference was statistically significant(P?0.05).(6)The number of endometrial peristalsis was 4.84±2.52 times /min,2.05±1.41 times /min,and 0.91±0.56 times /min,the difference was statistically significant(P?0.05).(7)The proportion of bidirectional endometrial movement was 3.45%,8.28% and19.95%,the proportion of static movement was 15.52%,33.12% and 47.27%,the proportion of local movement was 68.97%,53.81% and 32.54%,and the proportion of reverse movement was 17.24%,7.63% and 3.09%.The differences between the above groups were statistically significant(P?0.05).(8)The PI of uterine spiral artery were 0.88±0.44,0.80±0.25,and 0.74±0.20,among the three groups,and the difference was statistically significant(P?0.05).The RI of the three groups were 0.53±0.18,0.52±0.10 and 0.50±0.08,the differences were statistically significant(P?0.05).Conclusion:1.The ultrasonographic scoring system can objectively assess the endometrial receptivity on the day of transplantation,and it is not affected by the transplantation period and embryo type.When the ultrasound score of endometrial receptivity was less than 13 on the transplantation day,cancellation is suggested.2.The pregnancy rate and embryo implantation rate of the transplanted blastocyst were higher than those of the blastocyst at the cleavage stage when the endometrial receptivity scores of ultrasound are the same.3.Excessive peristalsis of the endometrium,irregular local movement of the endometrium and reverse movement of the endometrium can cause a decrease in clinical pregnancy rate and embryo implantation rate. |
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