Research question

What is the relationship between uterine volume before frozen-thawed embryo transfer (FET) and reproductive outcomes among adenomyosis patients?

Design

Clinical characteristics and outcomes of adenomyosis patients undergoing IVF and FET in a tertiary academic hospital were retrospectively analysed. Only first blastocyst transfer cycles were included. The main outcome measures included clinical pregnancy rate (CPR), miscarriage rate and live birth rate (LBR).

Results

A total of 158 adenomyosis patients were enrolled. Receiver operating characteristic (ROC) curve analysis indicated that uterine volume before FET was negatively related to LBR, with area under the curve of 0.622 (95% confidence interval [CI] = 0.531–0.712, P = 0.012). The cut-off value for the curve was 98.81 cm³. Grouped by the cut-off of uterine volume, 83 women were included in group A (≤98.81 cm³) and 75 in group B (>98.81 cm³). No significant difference was found in CPR between two groups. Compared with group A, the incidence of miscarriage in group B was significantly increased (51.28% versus 16.28%, P = 0.001). LBR in group B was markedly lower than in group A (25.33% versus 43.37%, P = 0.020). Logistic regression analysis revealed that, after adjusting for potential confounders, uterine volume before FET was not associated with CPR (odds ratio [OR] 1.149, 95% CI 0.577–2.286, P = 0.693) but was positively related to miscarriage rate (OR 8.509, 95% CI 2.290–2.575, P = 0.001).

Conclusions

Adenomyosis patients with larger uterine volume (>98.81 cm³) before FET might have a lower LBR due to higher incidence of miscarriage. Reduction of uterine volume before embarking on FET procedures should be recommended.

中文翻译：

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接受冻融胚胎移植的子宫腺肌病患者子宫体积与妊娠结局的相关性

研究问题

冻融胚胎移植（FET）前子宫体积与子宫腺肌病患者的生殖结果之间有什么关系？

设计

回顾性分析某三级医院接受IVF和FET的子宫腺肌病患者的临床特征和结局。仅包括第一次囊胚移植周期。主要结局指标包括临床妊娠率（CPR）、流产率和活产率（LBR）。

结果

共招募了 158 名子宫腺肌病患者。受试者工作特征 (ROC) 曲线分析表明，FET 前的子宫体积与 LBR 呈负相关，曲线下面积为 0.622（95% 置信区间 [CI] = 0.531–0.712，P  = 0.012）。该曲线的截止值为 98.81 cm ³。按照子宫体积的临界值分组，A组（≤98.81 cm ³）包括83名女性，B组（> 98.81 cm ³）包括75名女性。两组之间的CPR无显着差异。与A组相比，B组流产发生率显着增加（51.28% vs 16.28%，P  =0.001）。B 组的 LBR 明显低于 A 组（25.33% vs 43.37%，P = 0.020）。Logistic 回归分析显示，在调整潜在混杂因素后，FET 前的子宫体积与 CPR 无关（优势比 [OR] 1.149，95% CI 0.577–2.286，P  = 0.693）但与流产率正相关（OR 8.509 , 95% CI 2.290–2.575, P  = 0.001)。

结论

由于流产发生率较高，FET 前子宫体积较大 (>98.81 cm ³ ) 的子宫腺肌症患者可能具有较低的 LBR。应建议在开始 FET 手术之前减少子宫体积。