Impact Of Newly Diagnosed Endometrial Heterogeneous Echo During Controlled Ovarian Hyperstimulation On IVF/ICSI Pregnancy Outcomes:A Retrospective Cohortstudy

Objective:To evaluate the effect of endometrial heterogeneity echo diagnosed by transvaginal ultrasound on the outcome of pregnancy in vitro fertilization-embryo transfer during controlled ovarian hyperstimulation by retrospective cohort analysis,and to further explore the role of transvaginal ultrasound on endometrial lesion Diagnostic value.Methods:Retrospective analysis of all patients undergoing IVF/ICSI assisted pregnancy at the Reproductive Hospital Affiliated to Shandong University from January 2013 to June 2017.Strict inclusion criteria and exclusion criteria were established.After 649 patients entered the controlled ovarian hyperstimulation(COH)treatment cycle,transvaginal sonography(TVS)examination at least 2 times suggested that the endometrial echo was heterogeneous,among them,45 cases canceled the fresh embryo transfer due to abnormal endometrial echo,cryopreserved embryos and waited for hysteroscopy or new cycle transplantation.The remaining 604 cases were included in the study as a research group.According to the strict 1:3 matching principle,the same age(±1 year),infertility type(primary infertility or secondary infertility),and the cause of infertility were selected(women's fallopian tube related diseases and men's few,weak,azoospermia),ovulation promotion programs(super long,long,short,antagonists and other programs)and take into account as much as possible comorbidities(endometriosis,ovulation disorders,etc.)The infertile patients with normal endometrial echo were the control group(1812 cases).Analyze the basic data,basic case characteristics and main IVF/ICSI outcomes of the study group and the control group.Results(s):There was no statistically significant difference in age,BMI,basal endocrine level(day 3 serum FSH level,day 3 serum LH level,day 3 serum E2 level),indication for IVF/ICSI treatment,ovulation-promoting protocols,number of embryos transferred,number of days of embryo transfer,gonadotropins startup quantity and total gonadotropins administered between the two groups.In the study group and the control group,there was no statistically significant difference in the live birth rate(41.39%vs 41.89%,P=0.830),biochemical pregnancy rate(59.10%vs 62.25%,P=0.169),clinical pregnancy rate(51.49%vs 54.42%,P=0.212),clinical pregnancy miscarriage rate(17.04%vs 21.7%,P=0.076)and ectopic pregnancy rate(2.57%vs 1.32%,P=0.127).31 patients who canceled the cycle of fresh embryo transfer due to inhomogeneous echo of the endometrium received hysteroscopy.According to the results of hysteroscopy and some pathological findings,23 patients were found to have abnormal morphology of the uterine cavity,including endometrial polyps 15 cases(48.39%),4 cases of endometrial hyperplasia(12.90%),2 cases of chronic endometritis(6.45%),2 cases of intrauterine adhesions(6.45%),the remaining 8 cases(25.81%)were normal cavity.Conclusion(s):The newly diagnosed endometrial heterogeneous echo during controlled ovarian hyperstimulation does not affect the pregnancy outcome of in vitro fertilization-embryo transfer,and fresh embryo transfer can be continued.Transvaginal ultrasound has high diagnostic value for abnormal endometrial echo.