子宫内膜搔刮对体外授精-胚胎移植的影响

The Impact of Endometrium Injury on IVF-ET Outcomes

目的研究子宫内膜搔刮对不同病因不孕患者体外授精-胚胎移植(in vitro fertilization,IVF-ET)妊娠结局的影响;明确子宫内膜搔刮的适用人群,减轻患者痛苦,改善IVF-ET妊娠结局,为临床治疗提供理论基础。方法纳入2014年1月至2014年12月在首都医科大学附属北京妇产医院生殖中心接受常规体外受精-胚胎移植或单精子卵细胞胞浆内显微注射-胚胎移植(IVF/ICSI-ET)助孕的不孕患者300例。随机分为两组:搔刮组(endometrium injury,EI)(n=150)和未搔刮组(non-EI,NEI)(n=150)。搔刮组患者在胚胎移植前一月经周期的黄体中期对子宫内膜行浅表搔刮,未搔刮组则不予干预。所有研究对象均采用黄体中期长方案行控制性超促排卵,在阴道B超引导下行取卵术,受精后常规培养72h后进行胚胎移植。胚胎移植后2w测定血β-HCG>20IU为生化妊娠;胚胎移植后4-5w B超检测宫腔内可见妊娠囊者为临床妊娠。采用SPSS18.0统计软件包进行统计学分析。结果 300例入组患者中有27例未行胚胎移植,最终纳入本研究数据统计的EI组为135例,包括输卵管因素不孕51例,男性因素不孕46例,原因不明不孕38例;NEI组为138例,包括输卵管因素不孕59例,男性因素不孕51例,原因不明不孕28例。输卵管因素不孕和男性因素不孕患者EI组与NEI组间的年龄、体重指数(BMI)、不孕年限、基础FSH值、基础LH值、总Gn量、获卵数、内膜厚度等指标比较,差异无统计学意义(P>0.05);两组间种植率及临床妊娠率比较也无统计学意义(P>0.05);原因不明不孕患者EI和NEI组患者年龄、体重指数、基础FSH,LH,E2、窦卵泡数、总Gn用量、获卵数及内膜厚度间无明显差异。但EI组临床妊娠率较NEI组显著提高(63.2%vs.35.7%,P=0.04)。结论 1.子宫内膜搔刮可以改善原因不明不孕患者的IVF妊娠结局,提高IVF-ET的助孕效果。2.对于输卵管因素及男性因素不孕患者子宫内膜搔刮不能改善其IVF妊娠结局。

Objective：To investigate the effects of endometrium injury（EI）on the outcome of in vitro fertilization（IVF）in the subfertility women with different etiology. Methods：A total of 300 subfertility women receiving IVF-ET treatment in our center were enrolled from January 2014 to December 2014 and further divided into two groups：150 patients in the EI group underwent EI in the mid-luteal phase of the natural menstrual cycle before IVF-ET and 150 patients in the non-EI（NEI）grou All patients started their IVF treatment in the subsequent cycle with ovarian stimulation using the mid-luteal long protocol. Compare the outcome of IVF between EI and NEI groups in different etilolgy. Results：A total of 273 subfertility women were analyzed. 135 in EI group,including tubal factor infertility 51,male factor infertility 46 and unexplained infertility 38. 138 in NEI group,including tubal factor infertility 59,male factor infertility 51 and unexplained infertility 28. There was no significant difference in the baseline characteristics between the EI and NEI groups in all of three etiologies. The clinical pregnancy rates had no significant difference between EI and NEI groups in women with tubal factor infertility and women with male factor infertility. However,the clinical pregnancy rates were significantly higher in the EI group compared to the NEI group in women with unexplained infertility. Conclusions：EI can significantly improved IVF outcomes in women with unexplained infertility,but not in women with tubal factor infertility and male factor infertility.