辅助生殖技术治疗子宫畸形合并不孕

Assisted Reproduction Techniques Outcome for Congenital Uterine Malformation

【目的】分析64名子宫畸形患者行体外受精/单精子卵泡浆注射(IVF/ICSI)治疗的临床资料,对子宫畸形患者的助孕结局做出分析总结,以期为临床提供借鉴。【方法】回顾性分析2002年1月1日到2009年12月31日因不孕行IVF/ICSI治疗的子宫畸形患者,按照子宫畸形的类型进行分组,比较各组病人的基本资料及辅助生殖技术ART治疗结局。妊娠的患者追踪至分娩,比较自然流产率、早产率、活婴分娩率、新生儿体质量和分娩孕周以及有无合并畸形。【结果】因子宫畸形行ART治疗患者共64人,按照子宫畸形的类型分为4组,鞍形子宫13人,不完全纵隔子宫14人,单角子宫19人,双子宫18人。4组患者在年龄、不孕年限、基础FSH水平方面都没有差异,获卵数、受精率、卵裂率、优质胚胎率4组相似,平均每病人妊娠率在不完全纵隔子宫组(78.57%)显著高于鞍形子宫组(38.46%)和双子宫组(38.89%),与单角子宫组(47.37%)无统计学差异。4组均未出现宫外孕情况,在流产率、早产率、活婴分娩率、多胎妊娠率、分娩孕周和出生体质量方面均无统计学差异。所有出生婴儿均未发现有畸形。【结论】子宫畸形患者行IVF或ICSI有比普通不孕患者更差的临床妊娠率和种植率。不完全纵隔切除术后患者的临床妊娠率相对鞍形子宫和双子宫更高。

[Objective] A retrospective analysis was performed to evaluate the reproductive outcome of 64 women with uterine malformation who underwent in vitro fertilization （IVF） or intracytoplasmic sperm injection （ICSI） and embryo transfer （ET）. [ Methods ] Database of First Affiliated Hospital of Sun Ye-sen University were indexed to seek patients who with uterine malformation undergo ART from 1 January 2002 to 31 December 2009. Patients were grouped according to the type of uterine malformation and their clinical and laboratory data were be compared. Once the patient was pregnant we followed up until delivery. The miscarriage rate, preterm delivery rate, term delivery rate, weight of newborn, gestation weeks and congenital malformation rate were compared. [ Results ] We conducted a retrospective analysis of data from 64 patients with the following types of congenital uterine malformation ： 13 arcuate, 19 unicomate, 18 didelphys, 14 subseptate. There were no significant differences in the age, duration of infertility, bFSH, the number of oocytes retrived, fertility rate, cleavage rate, good quality embryo rate when the various types of uterine malformation were compared. Patients with subseptate uterus had significantly higher accumulation pregnant rate compared with patients with arcuate uterus and didelphys uterus （P 〈 0.05）. There was no difference in miscarriage rate, preterm delivery rate, take baby home rate, multiple pregnancy rate, weight of newborn, gestation weeks between four groups. There was no ectopic pregnancy and fetal anomaly in each group. [ Conclusion] Clinical pregnancy rate and implantation rate are worse in patients with uterine malformation compare with patients without uterine malformation. Patients with subseptate uterus underwent metroplasty before assisted reproduction had better clinical pregnancy rate compare with patients with arcuate uterus and didelphys uterus.