IVF-ET失败者行宫腔镜检查的临床价值

Hysteroscopic Interventions in Patients Undergoing Repeatedly in vitro Fertilization-embryo Transfer Who Failed to Conceive

目的:探讨IVF-ET失败者行宫腔镜检查的意义及其临床应用价值。方法:选取38例既往有IVF-ET失败史的患者行宫腔镜检查及手术(研究组),与同期常规行宫腔镜检查的不孕患者45例(对照组),就子宫内膜形态的不同表现类型临床结局等方面进行比较。结果:研究组宫腔内膜异常的发生率为84.21%,明显高于对照组的48.89%,其中宫腔粘连、子宫内膜不规则增生以及子宫内膜息肉的发生率均高于对照组(P<0.05)。研究组的32例于宫腔镜术后一年内再次行IVF/ICSI或冷冻胚胎移植术,17例获得临床妊娠。余6例术后至今未行IVF-ET,不避孕未孕。结论:宫腔镜检查、干预有利于改善子宫内膜的形态,提高临床妊娠率,可作为再次IVF前的常规筛查手段。

Objectives： To evaluate the efficacy and hysteroscopic findings in patients undergoing IVF-ET who failed to conceive. Methods： Thirty-eight cases who had previous failed IVF-ET （experimental group） and 45 cases with infertility （control group） were analyzed. Intrauterine lesions on hysteroscopy were compared. Results： The incidence of abnormal endometrial findings in experimental group （84.21%） was significantly higher than that in control group （48.89%）（P〈0.05）. Intrauterine adhesion （36.84% vs. 20.00%）, irregular endometrial hyperplasia （28.95% vs. 15.56%）, and endometrial polyps （13.16% vs. 6.67%） were also significantly higher in experimental group than in control group （P〈0.05）. Thirty-two in 38 patients underwent following IVF/ICSI cycle within one year, 17 cases achieved pregnancy, clinical pregnancy rate was 53.13%. Conclusion： Hysteroscopy is highly valuable and should be routinely performed to all infertility cases before IVF, especialy with in vitro fertilization and embryo transfer failure. The morphological characters of endometrium directly affected the outcome of IVF.