生殖器结核对体外受精-胚胎移植技术助孕的影响

Role of genital tuberculosis in IVF-ET outcomes

生殖器结核是输卵管性不孕的重要原因,也是发展中国家寻求体外受精-胚胎移植(IVFET)技术助孕治疗的主要病因。如果结核性不孕患者宫腔形态正常、卵巢功能良好,IVF-ET是治疗结核性不孕的有效方法。生殖器结核可以影响IVF-ET治疗结局,首先表现为能够降低卵巢储备功能。其次,影响胚胎着床,如潜伏性子宫内膜结核由于内膜基底层结核菌的存在,影响内膜下血流及激活抗磷脂抗体,诱发微血栓形成,使胚胎的着床失败;内膜结核可引起内膜粘连、瘢痕化及宫腔形态改变,影响胚胎着床。IVF-ET助孕治疗由于超促排卵,高雌孕激素水平可以激活陈旧结核,使潜伏性结核转为活动性结核。另外,结核患者包括生殖器结核患者妊娠后可以通过多种途径感染胎儿,导致新生儿先天性结核。因此,不孕患者在行辅助生殖技术(ART)助孕治疗前,需考虑筛查结核尤其生殖器结核。对于已确诊的结核感染应当规范地进行抗结核治疗;对于潜伏性结核,给予预防性治疗再行IVF-ET助孕会提高成功率,获得较好的妊娠结局。

Genital tuberculosis is a major cause of tubal infertility and seeking for in vitro fertilization （IVF） to assist reproduction in developing countries which is an effective method to treat tubercular infertility for a person who has a normal uterine cavity and functional ovaries. Genital tuberculosis can decrease ovarian reserve and affect the embryo implantation. For example, dormant mycobacterium present in the basal endometrial layer may appreciably reduce sub-endometrial blood flow （SEBF） and possibly interfere with implantation. Altered immune response in tuberculosis is known to activate antiphospholipids （aPL）, which in turn can lead to activation of aPL antibodies and microthrombosis, a known cause of implantation failure in aPL. What＇s more, endometrial adhesions, scars and deformation of uterine cavity can have an influence on embryo implantation. Latent genital tuberculosis can be reactivated by the high levels of estrogen and progestin IVF superovulation. Patients who have tuberculosis, including genital tuberculosis, can communicate tuberculosis mycobacterium to infant by any ways, which can lead to congenital tuberculosis. In a word, we should highlight the fact that TB should be considered and excluded in high-risk women before IVF. Women with genital tuberculosis or latent tuberculosis infection （LTBI） require early diagnosis timely and complete short-course anti-tuberculosis therapy （ATT） before initiating them into IVF-ET, so as to optimize their chance of achieving a successful live birth.