Hysteroscopy improves the pregnancy outcomes following fresh embryo transfer in patients with FIGO Type Ⅱ and Ⅲ uterine fibroids diagnosed by ultrasound
10.3760/cma.j.cn101441-20250321-00135
- VernacularTitle:宫腔镜手术改善超声诊断FIGO Ⅱ、Ⅲ型子宫肌瘤患者新鲜胚胎移植助孕结局
- Author:
Mengjie FAN
1
;
Liying WANG
;
Hua ZHANG
;
Shuo YANG
;
Caihong MA
;
Rong LI
Author Information
1. 北京大学第三医院妇产科生殖医学中心 国家妇产疾病临床医学研究中心（北京大学第三医院）辅助生殖教育部重点实验室（北京大学）北京市生殖内分泌与辅助生殖技术重点实验室，北京 100191
- Publication Type:Journal Article
- Keywords:
Hysteroscopy;
Pregnancy outcomes;
Uterine fibroids;
Fresh embryo transfer
- From:
Chinese Journal of Reproduction and Contraception
2025;45(10):1032-1037
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the impact of hysteroscopic surgery on fresh embryo transfer outcomes in patients with transvaginal ultrasound-diagnosed FIGO Type Ⅱ/Ⅲ uterine fibroids that may affect the uterine cavity morphology, providing a reference for clinical practice.Methods:A retrospective cohort study was performed to analyze the clinical data of 346 patients who visited the Reproductive Medicine Center, Department of Obstetrics and Gynecology, Peking University Third Hospital between January 2020 and December 2022, with transvaginal ultrasound findings indicating uterine fibroids adjacent to or protruding into the uterine cavity (FIGO Type Ⅱ, Ⅲ) and who underwent fresh embryo transfer. Patients were divided into two groups based on whether hysteroscopic surgery were performed: the hysteroscopic surgery group ( n=237, the group that underwent hysteroscopy before embryo transfer) and the non-surgery group ( n=109, the group that proceeded directly to embryo transfer without hysteroscopy). Basic patient characteristics and pregnancy outcomes were compared between the two groups. Multivariate logistic regression analysis was used to identify factors influencing clinical pregnancy rate and live birth rate. Results:The baseline characteristics showed no statistically significant differences between the two groups. The clinical pregnancy rate [44.3% (105/237)] and the live birth rate [32.5% (77/237)] following fresh embryo transfer in the hysteroscopic surgery group were significantly higher than those in the non-surgery group [31.2% (34/109), P=0.021; 18.3% (20/109), P=0.007], whereas the pregnancy loss rate showed no significant difference. Stratified analysis by age revealed that for patients aged <35 years, the clinical pregnancy rate [62.1% (54/87)] and the live birth rate [51.7% (45/87)] in fresh embryo transfer cycles were significantly higher in the hysteroscopic surgery group compared with the non-surgery group [30.8% (12/39), P=0.001; 25.6% (10/39), P=0.006]. Multivariate logistic regression analysis further confirmed that hysteroscopic surgery was an independent factor influencing live birth rate ( OR=2.128, 95% CI: 1.152-3.930, P=0.016). Among patients aged <35 years, hysteroscopic surgery was an influencing factor of both clinical pregnancy rate ( OR=4.222, 95% CI: 1.745-10.215, P=0.001) and live birth rate ( OR=3.449, 95% CI: 1.436-8.282, P=0.006). Conclusion:For infertile patients with ultrasound findings of uterine fibroids adjacent to or protruding into the uterine cavity, especially younger patients, hysteroscopy is recommended. It can improve pregnancy outcomes of fresh embryo transfer, increasing both the clinical pregnancy rate and the live birth rate.
