体外受精周期搔刮子宫内膜对妊娠结局的影响

Effect of endometrial stimulation on pregnancy outcome of in vitro fertilization patients

目的 探讨子官内膜搔刮对临床妊娠的影响.方法 选择2007年1月至2007年12月间的759例行体外受精-胚胎移植（IVF-ET）新鲜周期助孕的不孕患者,随机选择其中68例患者为治疗组（进行子宫内膜搔刮）,在IVF前周期月经4～5 d对子宫内膜行搔刮术 其余691例为对照组（未行子宫内膜搔刮）.两组患者的年龄、不育年限、不育原因、促性腺激素（Gn）天数、Gn用量、获卵数、移植胚胎数、受精率差异无统计学意义 比较两组患者的临床妊娠率 将两组患者再分为原发组、继发组,先比较诊刮组和非诊刮组内原发、继发不孕患者的妊娠结局,再分别比较两组间原发、继发不孕的妊娠结局 将两组患者再分为第1周期、≥第2周期组,先分别比较诊刮组和非诊刮组内第1周期、≥第2周期组不孕患者的妊娠结局、再分别比较两组第1周期、≥第2周期组的妊娠结局.结果 两组比较,临床妊娠率、流产及宫外孕率差异无统计学患义 两组间、两组内原发、继发组临床妊娠率、流产及官外孕率差异无统计学意义 治疗组、对照组第1周期临床妊娠率分别为38.89%和37.16%,差异无统计学意义,≥第2周期临床妊娠率分别为53.13%、34.33%,差异有统计学意义.结论 子官内膜搔刮从一定程度上可提高子宫内膜的容受性,尤其对于IVF反复失败患者子宫内膜搔刮显著提高再次助孕周期临床妊娠率.

Objective To analyze the effect of endometrial stimulation on the pregnancy outcome of patients undergoing in vitro fertilization-embryo transfer （IVF-ET）.Methods A total of 759 subjects were treated by fresh IVF at our hospital in 2007.Sixty-eight subjects received endometrial stimulation at Days 4-5 of menstruation before IVF while other 691 were controls without treatment.No significant difference was found between two groups in terms of duration and cause for infertility,day and dosage of Gn ,number of retrieved oocytes and transferred embryos and fertilization rate.The clinical pregnancy rate of two groups were analyzed.Firstly the clinical outcomes for the patients of primary or secondary infertility were compared in treatment and control groups respectively.Then the clinical outcomes of the patients in first cycle and later cycles were compared in treatment and control groups respectively.Results There were no significant differences in clinical pregnancy rate and incidence of abortion and ectopic pregnancy.For first cyclers,the clinical pregnancy rate showed no significant difference between two groups （38.89% vs 37.16%）.But for later cyclers,the clinical pregnancy rate was higher in the treatment group than that in the control group （53.13% vs 34.33%）.Conclusion Endometrial stimulation may improve endometrial receptivity to some extent.And it can boost the clinical pregnancy rate for those patients with a repeated implantation failure.