宫腔镜检查与阴道彩色多普勒超声检查结果在复发性植入失败患者子宫异常检测中的比较及相关性
Comparison and correlations between findings of hysteroscopy and vaginal color Doppler ultrasonography for detection of uterine abnormalities in patients with recurrent implantation failure.
作者信息
Navali Nazli, Kazemi Esmat Sadat, Azizi Hosein, Hakimi Parvin, Eghbali Elham
机构信息
Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Department of Obstetrics and Gynecology, Alzahra Hospital, Women s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
出版信息
Open Med (Wars). 2025 Jun 13;20(1):20251226. doi: 10.1515/med-2025-1226. eCollection 2025.
BACKGROUND AND AIM
Hysteroscopy is the gold standard for diagnosing endometrial and cervical canal pathology and can be used alone or in combination with other methods. The study aimed to compare abnormal findings of vaginal color Doppler ultrasonography (transvaginal sonography [TVS]) and hysteroscopy.
METHODS
This study involved 100 infertile women with a history of two or more failed implantations of fertilization (IVF) from January 2020 to January 2021 in the infertility ward of Al-Zahra Hospital in Tabriz, Iran. All patients underwent hysteroscopy and TVS in the follicular phase to examine the endometrial cavity. We calculated the sensitivity and agreement of TVS color Doppler compared to hysteroscopy and using appropriate statistical tests.
RESULTS
The overall proportion of abnormal findings was 69 and 66% through hysteroscopy and TVS. The sensitivity and kappa statistics of TVS compared to hysteroscopy were 95.6 and 93.2%, respectively. Endometrial polyps were the most common abnormalities in hysteroscopy (31%) and TVS (25%). In examining the relationship between hysteroscopy findings and vaginal color Doppler ultrasonography findings, a significant association was found between submucosal myoma and non-homogeneous myometrium (OR = 1.8 (1.02-5.3); = 0.027), endometrial polyps and non-homogeneous myometrium (OR = 2.7 (1.04-7.4); = 0.025), intrauterine adhesion and uterine artery PI (OR = 1.9 (1.3-8.2); = 0.001), endometrial atrophy and endometrial thickness (OR = 2.4 (1.01-4.5); = 0.034), and thick/irregular endometrium and adenomyosis (OR = 2.5 (1.4-15.9); = 0.001).
CONCLUSION
Abnormal findings of hysteroscopy and TVS were observed more in patients who have a history of two or more unsuccessful IVFs. Comparing and evaluating the relationship between them can be considered a positive prognostic factor and a better diagnosis for achieving pregnancy in the IVF procedure in women with a history of recurrent implantation failure.
背景与目的
宫腔镜检查是诊断子宫内膜和宫颈管病变的金标准，可单独使用或与其他方法联合使用。本研究旨在比较阴道彩色多普勒超声检查（经阴道超声检查[TVS]）和宫腔镜检查的异常发现。
方法
本研究纳入了2020年1月至2021年1月在伊朗大不里士的阿尔扎赫拉医院不孕不育病房就诊的100名有两次或更多次体外受精（IVF）植入失败史的不孕女性。所有患者在卵泡期接受宫腔镜检查和TVS检查，以检查子宫内膜腔。我们计算了TVS彩色多普勒相对于宫腔镜检查的敏感性和一致性，并使用了适当的统计检验。
结果
通过宫腔镜检查和TVS检查发现异常的总体比例分别为69%和66%。TVS相对于宫腔镜检查的敏感性和kappa统计值分别为95.6%和93.2%。子宫内膜息肉是宫腔镜检查（31%）和TVS检查（25%）中最常见的异常情况。在检查宫腔镜检查结果与阴道彩色多普勒超声检查结果之间的关系时，发现黏膜下肌瘤与子宫肌层不均匀之间存在显著关联（OR = 1.8（1.02 - 5.3）；P = 0.027），子宫内膜息肉与子宫肌层不均匀之间存在显著关联（OR = 2.7（1.04 - 7.4）；P = 0.025），宫腔粘连与子宫动脉搏动指数之间存在显著关联（OR = 1.9（1.3 - 8.2）；P = 0.001），子宫内膜萎缩与子宫内膜厚度之间存在显著关联（OR = 2.4（1.01 - 4.5）；P = 0.034），以及子宫内膜增厚/不规则与子宫腺肌病之间存在显著关联（OR = 2.5（1.4 - 15.9）；P = 0.001）。
结论
在有两次或更多次IVF失败史的患者中，宫腔镜检查和TVS检查的异常发现更为常见。比较和评估它们之间的关系可被视为一个积极的预后因素，有助于对有反复植入失败史的女性在IVF过程中实现妊娠进行更好的诊断。
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