经阴道配子输卵管内移植的临床初步研究

Clinical Study of Transvaginal Gamete Intrafallopian Transfer

目的:开展经阴道配子输卵管内移植(TV-GIFT)治疗不孕症,探讨其实用价值。方法:对46例不孕症患者(至少一侧输卵管通畅)行TV-GIFT 48个周期,采用卵泡刺激素(FSH)、绝经期促性腺激素(hMG)、绒毛膜促性腺激素(hCG)及促性腺激素释放激素激动剂(GnRH-a)/FSH-hMG-hCG长方案促排卵,阴道超声引导下穿刺取卵。改良上游法处理精液,以Jansen-Andersen输卵管导管系统经阴道向输卵管插管注入卵子和精子。结果:输卵管插管成功率为62.50％,平均每周期移植卵子(3.72±0.96)个。临床妊娠13例,周期妊娠率27.08％。6例分娩,出生婴儿6个;自然流产7例。结论:TV-GIFT是一种简单有效、易于掌握的助孕技术,有较高的妊娠率,与经腹GIFT相比,无需腹腔镜手术及麻醉。

Objective: To develop the technique of transvaginal gamete intrafallopian transfer (TV-GIFT) and to evaluate its effectiveness. Methods: By means of hysterosalpingography, TV-GIFT had been used to 46 infertile patients with at least one patent tube for 48 treatment cycles. Using follicle-stimulating hormone (FSH)/human menopausal gonadotropin (hMG)/human chorionic gonadotropin (hCG) or gonadotropin releasing hormone agonist (GnRHa)/FSH/hMG/hCG program, controlled ovarian stimulation was performed. Under the guiding of transvaginal ultrasound, oocytes retrieval was performed with needle aspiration. Semen samples were prepared with a modified Swim-up method. The Jansen-Anderson tubal catheter was introduced into a fallopian tube transvaginaily, and gametes were injected into the tube. Results: Trans-vaginal tubal catheterization was successfully performed in 62.50% of cases. The mean number of oocytes transferred was (3.72±0.96) per cycle. Thirteen cases became pregnancy (27.08% per cycle), 6 of them had given birth to 6 babies and 7 of them resulted in spontaneous abortions. Conclusing: TV-GIFT offers an acceptable pregnancy rate for infertile patients with at least one patent tube. The technique is simple and easy to perform. Compared with laparoscopically directed GIFT. TV-GIFT is a safe and minimally invasive intervention without anesthesia.