反复胚胎种植失败妇女的临床特点分析

Analysis of clinical characteristics of women with repeated implantation failure

目的探讨反复胚胎种植失败(RIF)妇女的临床特点。方法收集体外受精-胚胎移植(IVF-ET)治疗的774例不孕妇女,其中RIF妇女109例(RIF组),首次行新鲜胚胎移植妊娠妇女665例(对照组)。比较2组妇女的年龄、不孕年限、BMI、不孕类型、不孕原因、基础激素、受精方式和促排卵方案等。结果与对照组相比,RIF组妇女的年龄较高,不孕年限较长,双方因素、子宫内膜异位症(EMS)引起的不孕者比例以及使用促性腺激素释放激素(GnRH)激动剂短方案、GnRH拮抗剂方案、单纯氯米芬/促性腺激素促排卵方案者比例较高(P均<0.05);2组间不孕类型、BMI、血清基础卵泡刺激素、黄体生成素、雌激素水平及受精方式比较差异均无统计学意义(P均>0.05)。RIF妇女中,染色体检查结果异常者占7.8%,宫腔镜检查结果异常者占54.8%。结论部分RIF妇女存在染色体G带和宫腔异常,高龄和EMS患者易发生RIF。

Objective To analyze the clinical characteritics of women with repeated implantation failure（ RIF）. Methods A total of 774 women undergoing in vitro fertilization and embryo transfer（ IVF-ET）were recruited in this study. Among them,109 women had a history of RIF（ RIF group） and 665 were pregnant individuals receiving fresh embryo transfer for the first time（ control group）. Age,duration of infertility,body mass index（ BMI）,type of infertility,cause of infertility,basic hormone,insemination method and ovulation induction protocol were statistically compared between two groups. Results Compared with the control group,patients in the RIF group were older,had a longer history of infertility,higher proportion of infertility caused by both male and femal factors and endometriosis（ EMS）,and higher percentage of use of gonadotropin-releasing hormone-a（ GnRH-a） short protocol,GnRH antagonist protocol and clomiphene / ovulation induction（ all P〈0. 05）. Type of infertility,BMI,levels of serum basal follicle-stimulating hormone,luteinizing hormone and estrogen,and insemination method did not significantly differ between two groups（ all P〈0. 05）. In the RIF group,7. 8% of patients had chromesome abnormality and 54. 8% presented with abnormal outcomes detected by hysteroscopy. Conclusions Partial RIF women were found to have abnormal G-banding karyotype and uterine cavity abnormality. Women with EMS andolder age are prone to developing RIF.