| BackgroundEndometrial hyperplasia is defined as that the endometrium is stimulated by estrogen for a long time,lacks progesterone antagonism,and the endometrium continues to proliferate[1].In 2014,the World Health Organization classified it according to the presence or absence of cell atypical:(1)endometrial hyperplasia without atypical hyperplasia(EH)(2)endometrial hyperplasia(AH).The difference between AH and EH is that AH has cell atypia,but there is no evidence of obvious infiltration[2].Although the risk of EH progression to endometrial cancer is less than 5%,it will affect the fertility of patients[2].A meta-analysis showed that the live birth rate of natural pregnancy after conservative treatment of endometrial hyperplasia was only 14.9%[4].It is also pointed out that endometrial hyperplasia will reduce the fertility of patients in Chinese consensus,and the patients should be suggested to get pregnant promptly after the endometrium reversed[2].High risk factors of endometrial hyperplasia include anovulation,obesity,polycystic ovary syndrome(PCOS)[3],etc.The most harmful effect of endometrial hyperplasia on fertility is abnormal ovulation[5,6].And the endometrium is in a state of hyperplasia for a long time,lacks the transformation of secretory phase,has no ovulation,and the sperm and egg cannot combine,which directly leads to the occurrence of infertility.IVF-ET is considered a best way to improve the pregnancy outcome of patients with endometrial hyperplasia,but the pregnancy outcome is not related with whether it is complicated with endometrial atypical hyperplasia[7].In addition,some researchers believe that infertility patient swith atypical hyperplasia needs a long interval between progesterone treatment and embryo transfer and the pregnancy rate decreased[8].Up to now,there is few studies on pregnancy outcome and influencing factors for patients with endometrial hyperplasia under in vitro fertilization/intracytoplasmic sperm injection(ICSI).This paper aims to get clinical suggestions for improving the assisted pregnancy outcome of these patients by retrospectively study on the endocrine characteristics,clinical index in assisted reproductive process and pregnancy outcome of these patients.ObjectiveTo explore the related factors affecting the outcome of assisted reproduction in patients with different types of endometrial hyperplasia.MethodsThe clinical data of 509 patients who received the first cycle of in vitro assisted pregnancy and completed the first embryo transfer(fresh embryo or frozen embryo)in the Center for Reproductive Medicine,Shandong University from May 2010 to October 2020 were analyzed retrospectively.According to the pathological diagnosis of endometrial hyperplasia,they were divided into 451 patients in EH group and 58 patients in AH group.The clinical data of relevant patients were collected:age,height,weight,body mass index,menstrual history,past history,infertility history(infertility years,causes of infertility,types of infertility and infertility treatment history),pregnancy and childbirth history,gynecological surgery history,intimal thickness,basic endocrine level(follicle stimulating hormone,luteinizing hormone,estrogen,androgen,anti Muller’s hormone,thyroid hormone,prolactin),pregnancy assistance indications,ovulation promotion scheme,Gn medication time,total amount of Gn,HCG day intimal thickness,HCG day estrogen level.HCG day LH level,progesterone level on HCG day,number of retrieved eggs,proportion of fresh embryo and frozen embryo transfer,intimal preparation scheme,number of retrieved eggs,assisted pregnancy outcome.The basic endocrine characteristics,assisted prenancy process,assisted pregnancy outcome and influencing factors of patients in different groups were compared and analyzed.ResultPart Ⅰ:comparison between EH group and AH group1.Analysis of clinical characteristicsThere was no significant difference between the two groups in age,infertility years,infertility types,follicle stimulating hormone,luteinizing hormone,estrogen,anti Muller’s hormone,prolactin,androgen and thyroid stimulating hormone(P>0.05).BMI in EH group was lower than that in AH group(24.31 ±3.84 vs 26.65±4.27,P<0.05),and the proportion of patients with EH combination and PCOS was lower than that in AH group(11.09%vs 31.03%,P<0.05).The proportion of fresh embryo transfer in EH group was significantly higher than that in AH group(70.51%vs 46.57%,P<0.05).2.Pregnancy outcomeThe total clinical pregnancy rate in EH group was higher than that in AH group(54.76%vs 50.00%,P<0.05),the live birth rate in EH group was higher than that in AH group(45.90%vs 36.21%,P<0.05),and the total abortion rate in EH group was lower than that in AH group(17.81%vs 27.59%,P<0.05).The twin pregnancy rate,preterm birth rate and full-term birth rate in EH group were 18.22%,24.15%and 75.85%respectively.There were 9 cases of ectopic pregnancy.There were 2 cases of twin pregnancy,2 cases of preterm birth,19 cases of full-term birth and 3 cases of ectopic pregnancy in AH group.There was no significant difference in neonatal weight between EH group and AH group(P>0.05).3.Analysis of multiple factors affecting the outcome of assisted reproductiveAfter reducing confounding factors by logistic regression analysis,the results showed that there was no difference in clinical pregnancy rate between EH group and AH Group[P=0.265,OR=1.415,95%CI(0.768,2.609)],and there was no difference in live birth rate between EH group and AH Group[P=0.469,OR=0.469,95%CI(0.242,0.904)].The abortion rate in EH group was lower than that in AH Group[P=0.024,OR=0.469,95%CI(0.234,0.848)].Whether the patient is combined with PCOS has an impact on the clinical pregnancy rate and live birth rate[P=0.039,OR=0.606,95%CI(0.352,0.942)].[P=0.045,OR=0.764,95%CI(0.436,0.856)].BMI and the proportion of fresh embryo/frozen embryo transfer had no effect on the outcome.Part Ⅱ:Analysis subgroups based on whether with PCOSSubgroup analysis of PCOS patients and non PCOS patients showed that there was no difference in clinical pregnancy rate and live birth rate between EH group and AH Group[P=0.525,OR=1.489,95%CI(0.437,5.007)],[P=0.072,OR=3.525,95%CI(0.764,13.925)].The proportion of fresh embryo/frozen embryo transfer had a significant effect on the live birth rate[P=0.017,OR=0.813,95%CI(0.288,0.899)].In the non PCOS group,there was no difference in clinical pregnancy rate and live birth rate between EH group and AH Group[P=0.430,OR=1.022,95%CI(0.972,1.074)],[P=0.139,OR=1.039,95%CI(0.988,1.092)].The proportion of fresh embryo/frozen embryo transfer and BMI had no effect on the outcome.Conclusion1.Endometrial hyperplasia whether with atypical hyperplasia does not affect the first cycle clinical pregnancy rate,live birth rate and neonatal weight,but the abortion rate of patients with atypical hyperplasia is increased,in patients under IVF/ICSI.2.PCOS does affect pregnancy outcome of different types of endometrial hyperplasia in patients under IVF/ICSI.And the proportion of fresh or frozen transfer affects the outcome of patients with AH accompanied by PCOS. |
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