冻融胚胎移植前 CD38、CD138 联合筛查慢性子宫内膜炎对妊娠结局的影响

Objective To explore the pregnancy outcome of women with previous unpregnant embryo transfer (ET) cycles and screening chronic endometritis (CE) by hysteroscopic endometrial biopsy, CD38 and CD138 before the next frozen-thawed embryo transfer (FET). Methods A retrospective cohort study was conducted in Reproductive Center of Peking University Third Hospital from January 1st, 2015 to December 31st, 2018, including 2073 patients with previous unpregnant ET cycles and receiving hysteroscopic endometrial biopsy before FET. According to the pathological results of endometrium, the patients were divided into CE group (both CD38 and CD138 were positive), non-CE group (both CD38 and CD138 were negative), suspected group (one of CD38 or CD138 was positive), and unexamined group (no sign of CE in H&E stains or in the immunohistochemistry screening). The pregnancy outcomes after FET were compared among groups and logistic regression analysis was performed for live birth. Results There were no statistical differences in age, body mass index, duration of infertility, number of previous embryo transfer failures, basic follicle-stimulating hormone, number of antral follicles and endometrial thickness on the day of transfer among the four groups (all P>0.05). Unexamined group had the shortest interval between hysteroscopy and embryo transfer and less transferred embryos per cycle, and the differences were statistically significant [4(3,6) months, 4(2,6) months, 4(3,6) months and 3(2,6) months, P<0.001; 2(1,2), 2(1, 2), 2(1, 2) and 1(1, 2), P=0.037]. The pregnancy outcome of FET cycle was similar among the four groups including clinical pregnancy rate, ongoing pregnancy rate, early miscarriage rate and live birth rate (all P>0.05). Clinical pregnancy rate, ongoing pregnancy rate and live birth rate were higher in nonCE group without statistical difference (P>0.05). Multivariate regression analysis showed that treated CE did not affect live birth (OR=0.789, 95% CI=0.579-1.075, P=0.133). Conclusion Antibiotic treatment is recommended for patients with CE diagnosed by both CD38 and CD138 positive results, and the FET outcome of those patients is similar to patients without CE after treatment. Patients with either CD38 or CD138 positive have no adverse effects on pregnancy outcomes without treatment.