不孕症患者宫腔镜术后IVF胚胎移植时间的研究

Analysis Time Intervals in Vitro Fertilization(IVF) on the Obstetric Outcomes of Infertility Women after Hysteroscopy Operation

目的探讨不孕症患者宫腔镜检查中进行诊断性刮宫及IVF移植距宫腔镜检查时间的不同对妊娠结局的影响。方法回顾了159例宫腔镜检查术后接受IVF移植的患者资料,其中宫腔镜术中进行诊刮术的患者90例（A组）,未行诊刮69例（B组）,根据IVF胚胎移植距宫腔镜检查术的时间间隔不同,即1个月内、1~3个月、3个月后进一步分成3个亚组（A1、A2、A3和B1、B2、B3）,并分别对A组和B组及各个亚组间的IVF移植胚胎数、不良妊娠和临床分娩的结局情况进行统计比较。结果将A组与B组的足月产率（17.78%VS 15.94%）,早产率（1.11%VS 2.90%）和小于胎龄儿率（4.44%VS 4.35%）进行统计学比较,均没有差异（P〉0.05）;对A1、A2和A3三组的足月产率（20.00%VS 17.24%VS 14.29%）进行统计学比较,结果A1、A2组的足月产率与A3组之间差异是有统计学意义的（P〈0.05）,B1、B2和B3三组的足月产率（20.00%VS 16.67%VS 12.00%）,小于胎龄儿率（5.00%VS 4.17%VS 4.00%）进行统计学比较,结果没有显示差异具有统计学意义（P〉0.05）。结论宫腔镜检查中是否应用诊刮术对接受IVF治疗的不孕症患者的妊娠结局没有影响。在应用诊刮术的患者中,胚胎移植在术后3个月内进行不改变患者的妊娠结局,但3个月以上则降低成功分娩率;在非诊刮组中,宫腔镜检查与IVF移植间距时间不同,对患者的妊娠结局是没有影响的。

OBJECTIVE To investigate the value of diagnostic curettage in the hysteroscopy operation and the influence of different time intervals between hysteroscopy and in vitro fertilization（IVF） on the obstetric outcomes of the infertility women. METHODS The data of 159 patients undergoing hysteroscopy before IVF were retrospectively studied, there were 90 patients（A group） performed cu- rettage in hysteroscopy, other 69 patients（group B） unperformed. According to different time intervals from hysteroscopy to embryo transplantation, within 1 month, or from 1 to 3 months, or more than 3 months, the patients are further divided into three sub- groups（A1, A2, A3 and B1, B2, B3）. The obstetric outcomes of each group and each subgroup are statistically analyzed. RESULTS There are no statistical differences（P〉0.05） in full-term delivery rate（17.78% VS 15.94%）, preterm birth rate （1.11% VS 2.90%） and low weight birth rate（4.44% VS 4.35%） between group A and group B. There is no significantly statistical difference between group A1 and group A2（P〉0.05）, however there are statistical differences between group A1 and group A3, or group A2 and group A3 in full-term delivery rate（20.00% VS 17.24% VS 14.29%）（P〈0.05）. The rates of full-term delivery and low weight birth rate of group B1, group B2 and group B3（20.00% VS 16.67% VS 12.00%, 5.00% VS 4.17% VS 4.00%） were not significantly different（P〉 0.05）. CONCLUSIONS Whether curettage complicated in hysteroscopy before IVF, it had no effect on the pregnant outcomes in infer- tility women. The pregnant outcomes will not be changed if the time interval within 3 months between hysteroscopy and embryo trans- plantation in the infertility women undergoing curettage, but would be lower if it reach more than 3 month; in the women uncompli- cated curettage in hysteroscopy, there was no difference in delivery sequence if embryo transplantation delayed.