提高体外受精-胚胎移植妊娠率的临床策略探讨

The study of clinical strategies in improving the pregnancy rate of patients undergoing IVF-ET

目的 探讨提高体外受精-胚胎移植（IVF-ET）妊娠率的有效方法与策略。方法 2003-05—2005-06上海交通大学医学院附属瑞金医院生殖医学中心对进行IVF-ET的患者固定相关条件，采用超声下胚胎移植、雌二醇（E2）／孕酮（P）监测调控注射人绒毛膜促性腺激素（HCG）的时机及助孕术前行子宫内膜搔刮术，观察其对妊娠结局的影响。结果 超声下发现胚胎移植（ET）日子宫位置较预探有变化者占45．69％，其中深度增减超过5mm者达23．28％，其单胚种植率升高，两者比较差异有显著性意义。HCG日E2／P比值在3．01～4．00者妊娠率最高，〈1者无妊娠。超声观察子宫内膜形态不良者经搔刮术转为规则三线征者占63．64％，获得了与内膜形态良好患者相近的临床结局；经上述措施，临床妊娠率及单胚种植率逐年提高，最高达到53．85％和31．88％。结论 超声下ET和助孕术前子宫内膜搔刮术，对提高IVF—ET妊娠率显示了有效的价值，E2／P监测调控注射HCG时机的效果有待样本积累。

Objective To study the effective methods of improving the pregnancy rate in IVF-ET. Methods From May 2003 to June 2005, practice embryo transfer guided by ultrasound ,blood E2/P monitoring to regulate the timing of HCG injection and endometrium activation before IVF cycle respectively among patients undergoing IVF-ET in Reproductive Center of Ruijin Hospital Affiliated to Shanghai Jiaotong University, who had fixed other treatment procedure. Results We found that on the day of ET, nearly 45.69% patients uterus position changed and 23.28% patients uterus depth increased or decreased more than 5mm, implantation rate of those ET under B-ultrasound was higher than others. After choosing the timing of HCG injection by regulating blood E2/P, patients proportion of E2/P ratio between 3. 01 to 4. 00 increased obviously and the proportion of less than 1.0 decreased. Through endometrium activation, 63.64% patients＇ endometrium abnormal previously were improved and these patients got the same pregnancy rate as those having normal endonletrium. By exercising above strategies, our pregnancy and implantation rate had been increasing every year and reached 53.85% and 31.88% respectively. Conclusion ET under B-ultrasound and endometrium activation before IVF cycle shows their effect in improving the pregnancy rate of IVF-ET. While the definition of the value of monitoring blood E2/P to regulate the timing of HCG injection needs more samples.