宫腔镜在首次体外受精-胚胎移植失败患者中的意义

Significance of hysteroscopic in vitro fertilization-embryo transfer failures

目的探讨宫腔镜对首次体外受精-胚胎移植(IVF-ET)失败者子宫内异常的诊断和治疗的重要性。方法2004年2月～2005年3月该院腔镜中心对首次IVF-EF失败的53例患者(观察组)行宫腔镜检查,并与同期人工授精前进行宫腔镜检查的24例正常妇女(男性无精症)(对照组)进行比较分析。结果53例IVF-EF失败者中24例发现宫腔异常,占45.3%。其中12例为宫腔粘连,占50.0%;5例为宫腔息肉,占20.8%;4例为子宫肌瘤,占16.7%。24例人工授精者中仅3例宫腔有异常,占12.5%,二组差异有显著性(P<0.05)。所有异常患者均行相应治疗。观察组53例患者中50例在其后进行了再次IVF-ET术,共有19例获得妊娠,妊娠率为38.0%。结论宫腔镜能准确诊断和治疗IVF-ET失败者子宫腔内病变,提高IVF-ET的成功率,具有良好的可接受性。

[Objective] To investigate the essentiality of hysteroscopy in diagnosis and treatment of intrauterine lesions in failures of in-vitro fertilization-embryo transfer （IVF-ET）. [Methods] From February 2004 to March 2005, 53 previous IVF-ET failures （study group） referred to our endoscopy center underwent hysteroscopy and 24 women （control group） prepared to receive intrauterine insemination （masculine azzospermia） underwent hysteroscopy. We analyzed and compared the results. [Results] Twenty-four （45.3%） patients in study group had abnormal endometrial findings, as follows： Twelve patients （50%） had intrauterine adhesions , nine patients （20.8%） had endometrial polyps. Three （12.5%） patients in control group had abnormality. There was a significant difference in the two groups （p〈0.05）. All patients were performed with appropriate treatment to correct the lesions. 50 of the 53 underwent the second IVF-ET. Nineteen patients （38%） achieved succesful pregnancy. [ Conclusoins] The incidence of abnormal diagnosis and treatment on hysteroscopy is high in patients with failures of IVF-ET. Hysteroscopy can help to improve the clinical pregnancy rate and have gained general acceptance.