Objective: To investigate the effect of chronic endometritis (CE) on the clinical outcomes of patients with failure of first embryo transfer. Methods: A total of 5 605 cycles of frozen-thawed single blastocyst transfer in the reproductive center of the Third Affiliated Hospital of Zhengzhou University from January 2017 to June 2021 were retrospectively collected. After the failure of first embryo transfer, all patients underwent hysteroscopy, and when necessary, endometrial pathology and immunohistochemistry were combined to diagnose CE. Patients were divided into two groups: non-CE group (5 033 cycles) and CE treatment group (572 cycles). The main outcome was live birth rate and the secondary outcomes included clinical pregnancy rate and early abortion rate. The quantitative data were represented by Median (Q1, Q3). The rank sum test was used for comparison between groups. The factors related to live birth rate were analyzed by binary logistic regression model. Results: The incidence of CE was 10.21% (572 cycles) in patients with the failure of first embryo transfer. The maternal age in the non-CE group was 31.0 (29.0, 34.0) years old, and that in the CE treatment group was 31.0 (29.0, 34.0) years old (P<0.001). There was a statistically significant difference in endometrial preparation between the two groups (P=0.010). The endometrial thickness in the CE group was 9.0 (8.2, 10.3) mm on progesterone transformation day, which was higher than that of [9.5 (8.6, 11.0) mm] in the non-CE group (P<0.001). There was no significant difference in clinical pregnancy rate (60.3% (3 035 cycles) vs 63.1% (361 cycles), P=0.193), early abortion rate (17.1% (520 cycles) vs 20.5% (74 cycles), P=0.112) and live birth rate (49.2% (2 477 cycles) vs 49.3% (282 cycles), P=0.969) between the non-CE group and the CE treatment group. The maternal age, endometrial thickness on progesterone transformation day and blastocyst grade were related factors of the live birth rate, and the OR(95%CI) were 0.94 (0.93-0.96), 1.10 (1.06-1.14) and 2.07 (1.84-2.32)), respectively (all P<0.001). Compared with the non-CE group, the CE treatment group did not affect the live birth rate after transplantation, the aOR (95%CI) was 0.99 (0.82-1.18), P=0.882. Conclusions: For patients who underwent the failure of first embryo transfer, hysteroscopy is recommended before single frozen blastocyst transfer, and if necessary, combined with immunohistochemical screening for CE. After standardized treatment, CE patients could obtain similar clinical pregnancy rate, early miscarriage rate and live birth rate as non-CE patients.
目的： 分析慢性子宫内膜炎（CE）对首次胚胎移植失败患者临床结局的影响。 方法： 回顾性纳入2017年1月至2021年6月在郑州大学第三附属医院生殖医学科行冻融单囊胚移植周期，共5 605个周期，患者经历了首次胚胎移植失败后，均进行宫腔镜检查，必要时子宫内膜病理检查及免疫组化联合诊断CE。分为非CE组（5 033个周期）和CE治疗组（572个周期）。主要观察指标为活产率，次要观察指标为临床妊娠率和早期流产率。本研究计量资料采用M（Q1，Q3）表示，组间比较采用秩和检验。并采用二元逻辑回归模型分析对活产率的相关因素。 结果： 首次胚胎移植失败的患者的CE发生率为10.21%（572个周期）。非CE组女方年龄为31.0（29.0，34.0）岁，CE治疗组为31.0（29.0，34.0）岁（P<0.001）。两组患者子宫内膜准备方案差异有统计学意义（P=0.010）。CE组转化日子宫内膜厚度为9.0（8.2，10.3）mm，高于非CE组的9.5（8.6，11.0）mm（P<0.001）。非CE组和CE治疗组患者的临床妊娠率［60.3%（3 035个周期）比63.1%（361个周期），P=0.193］、早期流产率［17.1%（520个周期）比20.5%（74个周期），P=0.112］、活产率［49.2%（2 477个周期）比49.3%（282个周期），P=0.969］差异均无统计学意义。女方年龄、转化日子宫内膜厚度和移植囊胚级别是活产率的相关因素，OR值（95%CI）分别为0.94（0.93~0.96）、1.10（1.06~1.14）和2.07（1.84~2.32），均P<0.001。与非CE组相比，CE治疗组并不影响移植后的活产率，OR值（95%CI）为0.99（0.82~1.18），P=0.882。 结论： 对于首次胚胎移植失败的患者，再次冻融单囊胚移植前，建议宫腔镜检查，必要时结合组织病理学和免疫组化联合筛查CE，CE患者经规范治疗后，可获得与非CE患者相似的临床妊娠率、早期流产率及活产率。.