The importance of endometrial pattern and thickness to successful outcome in IVF and gamete intrafallopian transfer was first described by Smith et al. (1). They found that implantation did not occur, or occurred less often, if the endometrium lacked a triple-line pattern on the day of, or one day before, ovum retrieval in IVF cycles. This finding was later confirmed by others (2, 3). A triple-line endometrial pattern on the day of hCG administration in IVF cycles is relate to serum estradiol level, the number of mature oocytes, and the number of top-quality embryos and is unrelated to serum progesterone levels (3).

　　Smith等人較先描述了子宮內(nèi)膜形態(tài)和厚度對試管和配子輸卵管內(nèi)移植成功與否有重要作用(1)。他們發(fā)現(xiàn)，如果子宮內(nèi)膜在試管周期試管當(dāng)天或前一天沒有形成三線型形態(tài)，胚胎移植后就不會著床或者著床率低，后來其它研究也證實了這一發(fā)現(xiàn)(2，3)。試管周期hCG給藥當(dāng)天形成的三線型內(nèi)膜形態(tài)與血清雌二醇水平，成熟卵泡個數(shù)和專業(yè)胚胎個數(shù)相關(guān)，而與血清孕酮水平無關(guān)(3)。

　　Endometrial thickness

　　子宮內(nèi)膜厚度

　　Pregcy does not occur in IVF cycles, presumably because of failure of embryos to implant, if the endometrium is too thin on the day of hCG administration according to the majority of studies. However, other studies have reported no relationship between thickness and pregcy in IVF cycles. Many of the studies that failed to find a relationship between thickness and outcome compared mean thickness in conception and non-conception cycles, while most studies that found a relationship reported critical or “cut-off” values below which no pregcies occurred. In most studies, the critical thickness value is reported as 6mm, but the range is from 4mm (4) to 6mm (5). One reason for these differences is that endometrial thickness can change, either increasing or decreasing, between the day hCG is administered and the day implantation is presumed to occur, a difference of 8-9 days. Importantly, in all studies of oocyte donation, endometrial thickness on the day of embryo transfer has been found to be critical for implantation.

　　根據(jù)大多數(shù)研究結(jié)果，如果子宮內(nèi)膜在hCG給藥當(dāng)天太薄，胚胎可能無法著床，導(dǎo)致沒有懷孕。但是，也有其他研究發(fā)現(xiàn)試管周期中子宮內(nèi)膜厚度大小與是否懷孕之間沒有關(guān)系。許多研究通過對比受孕和非受孕周期的內(nèi)膜平均厚度得出內(nèi)膜厚度與懷孕不相關(guān)的結(jié)論，而大多發(fā)現(xiàn)這二者之間有關(guān)系的研究則認(rèn)為內(nèi)膜有一個臨界值，當(dāng)內(nèi)膜厚度低于該值時懷孕不會發(fā)生。多數(shù)研究認(rèn)為內(nèi)膜厚度的臨界值為6mm，但是總的范圍在4-6mm之間(4，5)。造成這些差異的一個原因是子宮內(nèi)膜厚度在hCG給藥當(dāng)天和預(yù)計移植當(dāng)天不同，中間相隔8-9天，內(nèi)膜厚度可能增加也可能減少。研究人員還有一個很重要的發(fā)現(xiàn)，即在所有試管周期中，胚胎移植當(dāng)天的子宮內(nèi)膜厚度對移植著床至關(guān)重要。

　　As is true for ovarian induction and intrauterine insemination, optimal ART pregcy and birth rates occur when endometrial thickness on the day of hCG administration is equal to or greater than 9mm (3) or 10mm (6). Endometrium that is too thick, 14mm or greater on the day of hCG administration, may reduce the chance of a clinical pregcy (3). Increased susceptibility to injury at the time of embryo transfer has been proposed as the reason for decreased clinical pregcies by Dickey et al., who found that biochemical pregcies were more frequent in IVF cycles when endometrial thickness was less than 9mm or greater than 13mm (3). No relationship between endometrial thickness on the day of hCG and biochemical pregcy was observed in IVF cycles in another stu (7). An excessively thick endometrium may have its origins in the previous cycles. It is common practice not to start ovulation induction in ART and intrauterine insemination cycles following menstruation when endometrial thickness is greater than 6mm.

　　與卵巢誘導(dǎo)排卵和宮腔內(nèi)人工授精類似，當(dāng)內(nèi)膜厚度在hCG給藥當(dāng)天大于或等于9mm (3)或者10mm(6)時，輔助生殖周期會出現(xiàn)較優(yōu)的妊娠率和出生率。內(nèi)膜過厚，厚度大于或等于14mm時可能會降低臨床妊娠率(3)。Dickey等人提出在胚胎移植時內(nèi)膜對損傷的敏感性增加是臨床妊娠率降低的原因，他們發(fā)現(xiàn)當(dāng)內(nèi)膜厚度小于9mm或者大于13mm時，試管周期更容易出現(xiàn)生化妊娠(3)。另一項研究發(fā)現(xiàn)試管周期中hCG給藥當(dāng)天內(nèi)膜厚度與生化妊娠沒有關(guān)系(7)。過厚的子宮內(nèi)膜可能來源于上一次周期。當(dāng)子宮內(nèi)膜厚度大于6mm時，通常做法是不開始卵巢誘導(dǎo)排卵或?qū)m腔內(nèi)人工授精周期。

　　Other ultrasound findings

　　其它超聲發(fā)現(xiàn)

　　Implantation rarely occurs when endometrial fluid is present on ultrasound on the day of embryo transfer, even when the fluid is aspirated (8). Endometrial polyps less than 2cm do not decrease pregcy rates, but there is a trend toward increased pregcy loss (9).

　　如果在胚移植當(dāng)天宮腔內(nèi)出現(xiàn)積液，即使將積液抽取出來，胚胎也很難著床(8)。小于2cm的內(nèi)膜息肉不會降低妊娠率，但有增加流產(chǎn)的趨勢(9)。

　　References

　　參考文獻

　　1. Smith B, Porter R, Ahuja K, Craft I. Ultrasonic assessment of endometrial changes in stimulated cycles in an in vitro fertilization and embryo transfer program. J IVF-ET 1984; 1:233-8.

　　2. Gonen Y, Casper RF, Jacobson W, Blankier J. Endometrial thickness and growth during ovarian stimulation: a possible predictor of implantation in in vitro fertilization. Fertil Steril 1989; 52: 446-50.

　　3. Dickey RP, Olar TT, Curole DN, Taylor SN, Rye PH. Endometrial pattern and thickness associated with pregcy outcome after assisted reproduction technologies. Hum Reprod 1992; 7: 418-21.

　　4. Sundstrom P. Establishment of a successful pregcy following in-vitro fertilization with an endometrial thickness of no more than 4mm. Hum Reprod 1998; 13: 1550-2.

　　5. Shoham Z, De Carlo C, Patel A, Conway GS, Jacobs HS. Is it possible to run a successful ovulation induction program based solely on ultrasound monitoring? The importance of endometrial measurements. Fertil Steril 1991; 56: 836-41.

　　6. Check JH, Nowroozi K, Choe J, Lurie D, Dietterich C. The effect of endometrial thickness and echo pattern on in vitro fertilization outcome in donor oocyte-embryo transfer cycle. Fertil Steril 1993; 59: 72-5.

　　7. Krampl E, Feichtinger W. Endometrial thickness and echo patterns. Hum Reprod 1993; 8: 1339.

　　8. Mansour RT, Aboulghar MA, Serour GI, Riad R. Fluid accumulation o the uterine cavity before transfer: a possible hindrance for implantation. J IVF-ET 1991; 8: 157-9.

　　9. Lass A, Williams G, Abusheikha N, Brinsden P. The effect of endometrial polyps on outcomes of in vitro fertilization cycles. J Assist Reprod Genet 1999; 16: 410-15.

【免責(zé)申明】本文由第三方發(fā)布，內(nèi)容僅代表作者觀點，與本網(wǎng)站無關(guān)。其原創(chuàng)性以及文中陳述文字和內(nèi)容未經(jīng)本站證實，本網(wǎng)站對本文的原創(chuàng)性、內(nèi)容的真實性，不做任何保證和承諾，請讀者僅作參考，并自 行核實相關(guān)內(nèi)容。如有作品內(nèi)容、知識產(chǎn)權(quán)和其他問題，請發(fā)郵件至yuanyc@vodjk.com及時聯(lián)系我們處理!