| Background and objectivesInfertility has become a worldwide health problem,in vitro fertilization/intracytoplasmic sperm injection embryo transfer(IVF/ICSI-ET)is an effective treatment for infertility.With the development of assisted reproductive technology(ART)and the optimization of embryo quality and quantity,endometrial receptivity and other factors still limit the improvement of pregnancy outcomes.EP is the most common intrauterine abnormality,reducing endometrial receptivity and affecting embryo implantation.Hysteroscopy is a safe and effective method of diagnosis and treatment of EP.At present,many infertility centers operate hysteroscopy(hard)examination under anesthesia in operating room,which has higher risk and cost.The purpose of this study is to investigate the etiology and clinical characteristics of EP in infertile women,and to study the clinical value of outpatient diagnostic hysteroscopy and curettage before IVF/ICSI-ET in treatment of EP and improvement of pregnancy outcomes.Materials and methodsClinical data of 2427 infertile patients who underwent soft hysteroscopy before IVF/ICSI-ET cycles in Qilu Hospital of Shandong University from January 2014 to June 2016 were retrospectively analyzed,including the incidence of EP,age,duration and type of infertility,pregnancy history,body mass index(BMI),blood pressure,fasting blood glucose(FBG),use of intrauterine device(IUD),clinical characteristics and so on.Analyze the pregnancy outcomes in patients treated by hysteroscopy and curettage with the control group.Results1?Hysteroscopy abnormal results of 561 cases included EP,endometritis,uterine malformations,endometrial hyperplasia,intrauterine adhesions,submucousmyoma,cervical adhesions and foreign matters.The total incidence of endometrial polyps was 16.03%,accounting for 70%of the intrauterine abnormalities(389 cases,the most common,P<0.05).The agreement rate of hysteroscopy and pathological examination was 93.86%.2?No significance was found in the age,mean menstrual interval,BMI,basal estradiol(E2)level,basal progesterone(P)level and FBG of EP group compared with the control group(P>0.05).But the duration of infertility(4.51 vs 3.61)and mean menstrual duration(5.85 vs 5.28)were significantly higher than those of the control group(P<0.05),while the number of pregnancy(0.27 vs 1.11),ectopic pregnancy(0.14 vs 0.25),abortion(0.42 vs 0.58),and production(0.16 vs 0.26)were significantly lower than those of the control group(P<0.05).3?The incidence of EP before 35 years old is higher,more than 35 years old was decreased significantly(17.54%vs 10.44%,P<0.05).4?The incidence of EP was relevant with the duration of infertility.The duration was divided into 6 groups and different incidence of EP were observed:13.37%for 1?3 years,16.08%for 4~6 years,20.39%for 7?9 years,26.32%for 10?12 years,29.41%for>15 years.With the increase of duration,the incidence of EP increased(P<0.05).5.The incidence of EP in primary infertility was higher than that in secondary infertility(19.44%vs 12.97,P<0.05).The incidence of EP decreased significantly with the number of pregnancy,abortion and production(P<0.05).The number of pregnancy was divided into 4 groups and different incidence of EP were observed:19.44%for 0 time,14.93%for 1?2 times,8.97%for 3?4 times,0 for>4 times(P<0.05).The number of abortion was divided into 4 groups and different incidence of EP were observed:17.72%for 0 time,13.81%for 1?2 times,8.79%for 3?4 times,0 for>4 times(P<0.05).The number of production was divided into 3 groups and different incidence of EP were observed:17.78%for 0 time,10.61%for once,4.76%for twice,0 for>4 times(P<0.05).6?The incidence of EP in patients who had used IUD was significantly lower than that in patients who had never used it(9.58%vs 16.5%,P<0.05).7?The incidence of EP in hypertensive patients was significantly higher than that in patients with normal blood pressure(35%vs 15.71%,P<0.05).8?The incidence of prolonged menstrual bleeding,heavy menstrual bleeding,frequent menstrual bleeding was significantly higher in patients with EP than in controls(13.62%vs 7.21%,4.63%vs 2.45%,7.97%vs 5.50%,respectively,P<0.05).9?There was no significant difference in clinical pregnancy rate and LBR per cycle,cumulative clinical pregnancy rate(CPR)and cumulative live birth rate(CLBR)of EP treated with hysteroscopy compared with the control group(51.56%vs 49.71%,49.69%vs 46.57%,71.3%vs 69.65%,69.51%vs 67.23%,respectively,P>0.05).Conclusions1?Endometrial polyp is the most common type of intrauterine abnormalities in infertile patients.2?The incidence of EP is related to duration of infertility,infertility type,pregnancy history,hypertension,and IUD use.Increased duration of infertility,primary infertility,and hypertension are risk factors of EP,while increased number of pregnancy and production,IUD use are the protective ones.3?Patients with EP are more prone to heavy menstrual bleeding,prolonged menstrual bleeding,and frequent menstrual bleeding than the control group.4?Hysteroscopy is an accurate diagnosis method of EP in infertility patients.Outpatient soft hysteroscopy with curettage can effectively treat EP,improve the uterine environment,and improve the pregnancy rate and live birth rate in IVF/ICSI-ET treatment cycle,which can be an effective,safe,and economic routine pre-operative examination. |
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