| Objective(s):By analyzing the occurrence of endometrial inflammatory changes in patients with polycystic ovarian syndrome(PCOS)and the effects of endometritis on IVF pregnancy outcomes of PCOS patients,to explore whether endometrial inflammatory changes were involved in the changes of endometrial receptivity of PCOS.Methods:According to the inclusion criteria,349 patients with PCOS and tubal factor infertility who received the first IVF-ET treatment in the Assisted reproduction Center of our hospital from January 1,2022 to December 31,2022 were enrolled.According to whether they had PCOS or not,they were divided into PCOS experimental group(group of hysteroscopy and endometrial examination before IVF treatment,n=164),PCOS control group(group of no hysteroscopy and endometrial examination before IVF treatment,n=107)and normal control group(tubal factor infertility group undergoing hysteroscopy and endometrial examination before IVF treatment,n=78).The incidence of chronic endometritis(CE)in PCOS experimental group and normal control group was compared.With CE as the dependent variable,binary Logistic regression analysis was performed for variables with P < 0.1 in the univariate analysis to explore the factors related to the occurrence of CE.Pregnancy outcome of IVF-ET treatment among all groups was compared,key indexes of IVF-ET treatment outcome among all groups were compared,and the influence of PCOS on Pregnancy outcome was analyzed.The pregnancy outcome of CE positive patients in PCOS experimental group was compared with that in PCOS control group,and the effect of endometritis on pregnancy outcome was discussed.Results:1.The incidence of basal testosterone(b T),insulin resistance(IR),antiMueller hormone(AMH),basal luteinizing hormone(b LH)and body mass index(BMI)in PCOS experimental group and PCOS control group were higher than those in normal control group,and the difference was statistically significant(P < 0.05).The basic follicle-stimulating hormone(b FSH)of PCOS experimental group and PCOS control group was lower than that of normal control group,and the difference was statistically significant(P<0.05).2.There were no significant differences in MII oocyte rate,cleavage rate,normal insemination rate,number of available embryos,number of high-quality embryos,rate of high-quality embryos,number of blastocysts and blastocyst formation rate among the three groups(P > 0.05).3.The positive rate of CE diagnosed by hysteroscopy was 26.45%,and that by CD138 immunohistochemical examination was 37.60%.The positive rate of CE diagnosed by combined examination was 47.93%,and the positive rate of CE diagnosed by combined examination was higher than that by single hysteroscopy or CD138 immunohistochemical examination,with statistical significance(P < 0.05).The positive rate of CD138 immunohistochemical examination was higher than that of hysteroscopy,and the difference was statistically significant(P=0.009).The Kappa coefficient of consistency for CE diagnosis was 0.279,95%CI(2.081 ～ 6.868),P < 0.001.4.With CE as the dependent variable,binary Logistic regression analysis was performed on variables with P <0.1 in univariate analysis,and BMI[OR=0.797,95%CI(0.669～0.949),P=0.011],b LH[OR=1.252,95%CI(1.064～1.473),P=0.007],AMH[OR=0.858,95%CI(0.746～0.987),P=0.032],BMI,b LH,AMH as predictive indicators of the occurrence of CE to make ROC curve.The areas under ROC curve of B MI,b LH,AMH and CE were 0.581(P=0.072),0.461(P=0.388)and 0.570(P=0.123),respectively.5.The incidence of CE in the PCOS experimental group was higher than that in the normal control group(52.44%vs38.46%),and the difference was statistically significant(P=0.042).The abortion rate of PCOS control group was higher than that of PCOS experimental group and normal control group(21.74%vs9.20%,P=0.028;21.74%vs6.12%,P=0.020),there was no significant difference in abortion rate between the PCOS experimental group and the normal control group(P=0.528).The HCG positive rate,biochemical rate and clinical pregnancy rate were not different among the three groups.There is no difference in pregnancy outcome between CE positive patients and CE negative patients after treatment.Conclusion(s):1.PCOS had no effect on oocyte development and quality,insemination,embryo development and quality.2.The diagnosis of CE by hysteroscopy and CD138 immunohistochemistry has a general consistency.The combined application of hysteroscopy and CD138 immunohistochemistry can improve the detection rate of CE.3.The incidence of CE increases in PCOS patients due to metabolic disorders,among which BMI,b LH and AMH are related to the incidence of CE,but BMI,b LH and AMH cannot be used as indicators to predict the occurrence of CE.4.PCOS affect endometrial receptivity and thus affect pregnancy outcome mainly through endometrial inflammatory changes.There is no difference in pregnancyoutcome between CE positive patients and CE negative patients after oral antibiotic treatment,and CE treatment can improve adverse pregnancy outcome. |
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