Pelvic floor neuromuscular electrical stimulation in treatment of patients with thin endometrium

doi:10.3877/cma.j.issn.1673-5250.2021.02.013

Objective

To investigate the effects of pelvic floor neuromuscular electrical stimulation (PFNES) on endometrial thickness (ET), blood perfusion and pregnancy in patients with TE.

Methods

A total of 96 outpatients with TE in the Department of Reproductive Medicine and Department of Reproductive Endocrinology, West China Second University Hospital, Sichuan University and had fertility needs from May 2016 to May 2018 were selected as research subjects. According to whether patients received PFNES therapy or not, they were divided into study group (n=51, received estrogen and PFNES therapy) and control group (n=45, only received estrogen therapy). ET, uterine artery pulsation index (PI), resistance index (RI), ratio of systolic to diastolic duration (S/D) before and after treatment in two groups were compared between groups and within groups by independent-samples t test and pairwise t test. Comparisons of spontaneous pregnancy rate and abortion rate between two groups were performed by chi-square test. All patients signed clinical research informed consents. This study was approved by the Ethics Committee of West China Second University Hospital, Sichuan University (Approved No.2015026). There were no statistical differences between two groups in age, years of infertility, basic estradiol, follicle stimulating hormone (FSH), luteinizing hormone (LH) levels, and ET, uterine artery PI, RI, S/D before treatment and other general clinical data (P>0.05).

Results

①After treatment, ET of TE patients in study group was (9.2±1.1) mm, which was significantly higher than that before treatment (5.4±0.8) mm, and also significantly higher than that of control group (7.9±0.7) mm, and differences were statistically significant (t=6.327, 4.352, P all<0.001). ②After treatment, uterine artery PI, RI and S/D of TE patients in study group were (0.52±0.16), (0.23±0.06), and (2.05±0.29), respectively, which were significantly lower than those before treatment (0.89±0.23), (0.79±0.22), and (4.86±1.02), and also significantly lower than those of control group of (0.78±0.12), (0.67±0.14) and (3.92±1.02), and all differences were statistically significant (t=4.178, 6.743, 7.246, 6.583, 5.235, 5.932; P all<0.001). ③One year after treatment in two groups, spontaneous pregnancy rate of study group was 43.1% (22/51), which was significantly higher than that of control group 13.3% (6/45), and the difference was statistically significant (χ²=10.279, P=0.001); while there was no statistically significant difference in abortion rate between two groups (P>0.05).

Conclusions

The treatment of PFNES can increase ET of TE patients, improve endometrial blood perfusion and receptivity, thus improving spontaneous pregnancy rate of patients.

Key words: Electric stimulation therapy, Pelvic neuromuscular electrical stimulation, Thin endometrium, Thickness of endometrium, Endometrial blood perfusion, Pregnancy rate, Female

表1 2组TE患者相关临床资料比较(±s)

组别	例数	年龄(岁)	不孕年限(年)	基础雌二醇水平(pg/mL)	基础FSH水平(IU/L)	基础LH水平(IU/L)
研究组	51	31.2±4.0	4.0±1.3	52.5±16.3	7.3±2.5	7.6±2.6
对照组	45	29.6±4.6	3.8±1.1	53.3±13.7	8.2±2.9	6.3±1.9
t值		0.874	1.442	0.446	1.361	0.517
P值		0.384	0.153	0.657	0.177	0.606

表1 2组TE患者相关临床资料比较(±s)

组别	例数	年龄(岁)	不孕年限(年)	基础雌二醇水平(pg/mL)	基础FSH水平(IU/L)	基础LH水平(IU/L)
研究组	51	31.2±4.0	4.0±1.3	52.5±16.3	7.3±2.5	7.6±2.6
对照组	45	29.6±4.6	3.8±1.1	53.3±13.7	8.2±2.9	6.3±1.9
t值		0.874	1.442	0.446	1.361	0.517
P值		0.384	0.153	0.657	0.177	0.606

表2 2组TE患者治疗前、后ET值及子宫动脉PI、RI、S/D比较(±s)

组别	例数	ET值(mm)				PI
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
研究组	51	5.4±0.8	9.2±1.1	6.327	<0.001	0.89±0.23	0.52±0.16	4.178	<0.001
对照组	45	5.1±0.6	7.9±0.7	1.562	0.136	0.82±0.17	0.78±0.12	1.343	0.161
t值		1.236	4.352			1. 279	6.583
P值		0.182	<0.001			0.176	<0.001
组别	例数	RI				S/D
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
研究组	51	0.79±0.22	0.23±0.06	6.743	<0.001	4.86±1.02	2.05±0.29	7.246	<0.001
对照组	45	0.72±0.23	0.67±0.14	1.169	0.198	4.55±1.29	3.92±1.02	1.096	0.216
t值		1.056	5.235			1.529	5.932
P值		0.237	<0.001			0.123	<0.001

表2 2组TE患者治疗前、后ET值及子宫动脉PI、RI、S/D比较(±s)

组别	例数	ET值(mm)				PI
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
研究组	51	5.4±0.8	9.2±1.1	6.327	<0.001	0.89±0.23	0.52±0.16	4.178	<0.001
对照组	45	5.1±0.6	7.9±0.7	1.562	0.136	0.82±0.17	0.78±0.12	1.343	0.161
t值		1.236	4.352			1. 279	6.583
P值		0.182	<0.001			0.176	<0.001
组别	例数	RI				S/D
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
研究组	51	0.79±0.22	0.23±0.06	6.743	<0.001	4.86±1.02	2.05±0.29	7.246	<0.001
对照组	45	0.72±0.23	0.67±0.14	1.169	0.198	4.55±1.29	3.92±1.02	1.096	0.216
t值		1.056	5.235			1.529	5.932
P值		0.237	<0.001			0.123	<0.001

表3 2组TE患者治疗后1年后妊娠结局比较[例数(%)]

组别	例数	自然妊娠	流产^a
研究组	51	22(43.1)	3(13.6)
对照组	45	6(13.3)	3(50.0)
χ²值		10.279	—
P值		0.001	0.080

表3 2组TE患者治疗后1年后妊娠结局比较[例数(%)]

组别	例数	自然妊娠	流产^a
研究组	51	22(43.1)	3(13.6)
对照组	45	6(13.3)	3(50.0)
χ²值		10.279	—
P值		0.001	0.080

[1]	Riad ON, Hak AA. Assessment of endometrial receptivity using Doppler ultrasonography in infertile women undergoing intrauterine insemination[J]. Gynecol Endocrinol, 2014, 30(1)：70-73. DOI: 10.3109/09513590.2013.859668.
[2]	Kasius A, Smit JG, Torrance HL, et al. Endometrial thickness and pregnancy rates after IVF: a systematic review and Meta-analysis[J]. Hum Reprod Update，2014，20(4)：530-541.DOI: 10.1093/humupd/dmu011.
[3]	黎雪茹，王中海. 薄型子宫内膜的研究进展[J/CD]. 中华妇幼临床医学杂志(电子版), 2015, 11(1): 109-112. DOI: 10.3877/cma.j.issn.1673-5250.2015.01.027.
[4]	郝洁，李艳萍. 薄型子宫内膜的诊治现状[J]. 实用妇产科杂志，2019, 35(2): 84-86.
[5]	Lebovitz O, Orvieto R. Treating patients with " thin" endometrium - an ongoing challenge[J]. Gynecol Endocrinol, 2014, 30(6): 409-414. DOI: 10.3109/09513590.2014.906571.
[6]	Liu KE, Hartman M, Hartman A．Management of thin endometrium in assisted reproduction: a clinical practice guideline from the Canadian Fertility and Andrology Society[J]．Reprod Biomed Online, 2019, 39(1): 49-62. DOI: 10.1016/j.rbmo.2019.02.013.
[7]	Momeni M, Rahbar MH, Kovanci E. A Meta-analysis of the relationship between endometrial thickness and outcome of in vitro fertilization cycles[J]. J Hum Reprod Sci, 2011, 4(3): 130-137. DOI: 10.4103/0974-1208.92287.
[8]	Bodombossou-Djobo MM, Zheng C, Chen S, et al. Neuromuscular electrical stimulation and biofeedback therapy may improve endometrial growth for patients with thin endometrium during frozen-thawed embryo transfer: a preliminary report[J]. Reprod Biol Endocrinol, 2011, 9(1): 122.DOI: 10.1186/1477-7827-9-122.
[9]	范祎，黄柳，范瑾，等. 盆底仿生物电刺激治疗薄型子宫内膜的临床研究[J]. 中国妇幼保健，2016, 31(10): 2215-2216. DOI: 10.7620/zgfybj.j.issn.1001-4411.2016.10.73.
[10]	薛惠英，左阳花，冯播，等. U8仿生物电刺激治疗薄型子宫内膜不孕症的临床研究[J]. 重庆医学，2013, 42(7): 2505-2507. DOI：10.3969/j.issn.1671-8348.2013.20.024.
[11]	罗一平，何洁仪，肖丽. 盆底神经肌肉电刺激改善薄型子宫内膜患者子宫内膜厚度及血流灌注的研究[J]. 中国妇幼保健，2015, 30(20): 3496-3498. DOI：10.7620/zgfybj.j.issn.1001-4411.2015.20.62.
[12]	薛惠英，仲纪祥，左阳花，等. 盆底仿生物电刺激干预治疗薄型子宫内膜患者的冷冻胚胎移植结局[J]. 生殖医学杂志，2015, 24(1): 12-16. DOI：10.3969/j.issn.1004-3845.2015.01.003.
[13]	胡艳，光晓燕，李环，等. 仿生物电刺激改善薄型子宫内膜厚度及血流灌注的研究[J]. 罕少疾病杂志，2013, 20(6): 17-19. DOI：10.3969/j.issn.1009-3257.2013.06.005.
[14]	樊琳，刘风华. 盆底仿生物电刺激治疗在薄型子宫内膜患者行冷冻胚胎移植周期中的临床疗效[J]. 中华生物医学工程杂志，2018, 24(1): 38-42. DOI：10.3760/cma.j.issn.1674-1927.2018.01.008.
[15]	杨云洁，史文静，程芳. 仿生物理电刺激治疗对人工终止妊娠术后子宫内膜修复的临床疗效[J/CD]. 中华妇幼临床医学杂志(电子版), 2021, 17(1): 93-98. DOI: 10.3877/cma.j.issn.1673-5250.2021.01.014.
[16]	Takasaki A, Tamura H, Miwa I, et al. Endometrial growth and uterine blood flow: a pilot study for improving endometrial thickness in the patients with a thin endometrium[J]. Fertil Steril, 2010, 93(6): 1851-1858. DOI: 10.1016/j.fertnstert.2008.12.062.

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