不孕症合并子宫内膜非典型增生患者助孕治疗的临床分析

Assisted reproductive treatment following conservative management of endometrial hyperplasia with atypia in infertile women

目的探讨不孕症合并子宫内膜非典型增生患者经保守治疗后助孕治疗的疗效和安全性。方法回顾性分析8例不孕症合并子宫内膜非典型增生患者,经孕激素或促性腺激素释放激素激动剂(GnRHa)治疗子宫内膜非典型增生缓解后,采用助孕治疗,观察助孕治疗的疗效及其对子宫内膜的影响。结果经孕激素或GnRHa治疗后,8例患者子宫内膜非典型增生全部缓解。共进行单纯促排卵治疗7个周期,促排卵联合人工授精2个周期,体外受精-胚胎移植(IVF-ET)7个周期,冻融胚胎移植2个周期。单纯促排卵周期均未妊娠,人工授精1个周期双胎妊娠;7个IVF-ET周期中,胚胎移植6个周期,3个周期获得临床妊娠;冻融胚胎移植1个周期获得临床妊娠。现足月分娩6活婴。1例未妊娠患者在促排卵后4个月发现子宫内膜癌变。结论不孕症合并子宫内膜非典型增生的患者经孕激素或GnRHa治疗缓解后,及时助孕治疗能提高妊娠率,但需严密观察,注意子宫内膜癌发生的可能。

Objective To evaluate the outcomes of assisted reproductive treatment following conservative management of endometrial hyperplasia with atypia in infertile women. Methods A retrospective analysis of the outcomes of assisted reproductive treatment was performed on eight infertile women, who underwent conservative management of endometrial hyperplasia with atypia. The outcomes of infertility treatment and postinfertility endometrial findings were assessed, Results Endometrial hyperplasia with atypia in all of the 8 women turned to be normal endometrium after treatment of progestational agents or gonadotrophin - releasing hormone agonist （GnRHa）. The patients underwent seven ovulation induction cycles of clomiphene citrate or human menopausal gonadotrophin （HMG）, two cycles of insemination, seven cycles of in vitro fertilization - embryo transfer （IVF - ET） and two cryopreserved cycles of IVF. Five out of the eight women achieved pregnancies with assisted reproductive treatment; six healthy offspring were delivered and one woman was on pregnancy. One woman was unable to have transfered embryos due to thin endometrium and developed to adenocarcinoma after the second cycle of IVF. Conclusions Assisted reproductive treatment following conservative management of endometrial hyperplasia with atypia in infertile women is an option for carefully selected women.