288例助孕失败患者宫腔镜微创术后再次妊娠结局分析

Re-pregnancy outcome of mini-invasive hysteroscopic surgery: an analysis of 288 patients with failed assisted reproduction

目的:探讨体外受精-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection-embryo transfer,IVF/ICSI-ET)种植失败患者行宫腔镜微创术(hysteroscopy minimally invasive surgery,HMIS)后再次妊娠结局。方法:回顾分析2013年1月至2015年11月行IVF/ICSI-ET治疗至少移植失败1次,于冻融胚胎移植术(frozen-thawed embryo transfer,FET)前进行HMIS诊疗的288例患者的临床资料,观察并分析其宫腔异常情况及再次妊娠结局。结果:288例患者中宫腔异常者多于宫腔正常者(P<0.01);宫腔异常类型中子宫内膜息肉所占比例(62.66%)最多;继发不孕患者宫腔异常率为90.48%(228/252),高于原发不孕患者(P<0.01)。FET前同意行HMIS诊疗患者(实验组)与FET前未同意行HMIS诊疗患者(对照组)比较,两组在不孕类型、不孕原因、年龄、不育年限、移植失败次数、FET内膜准备方案、移植日子宫内膜厚度、移植胚胎数等差异均无统计学意义的情况下,实验组胚胎种植率、临床妊娠率均高于对照组(P<0.01)。结论:对IVF/ICSI-ET失败患者,在下周期IVF/ICSIET或FET治疗前进行HMIS诊治,可有效改善子宫内膜容受性,提高胚胎种植率及临床妊娠率。

Objective： To investigate the re-pregnancy outcome of mini-invasive hysteroscopic surgery（ HMIS） for patients with failed in vitro fertilization / intracytoplasmic sperm injection-embryo transfer（ IVF / ICSI-ET）. Methods： A retrospective analysis was made on the clinical data of 288 patients who underwent HMIS before frozen-thawed embryo transfer（ FET） from Jan. 2013 to Nov.2015 in center for reproductive medicine in Guiping City People＇s Hospital,they suffered from failed IVF / ICSI-ET at least once,the uterine cavity abnormalities and re-pregnancy outcomes were observed and analyzed. Results： In the 288 patients,patients with abnormal uterine were more than those with normal uterine cavity（ P〈0. 01）. The proportion of uterine endometrial polyps in abnormal uterine cavity was 62. 66%; incidence of abnormal uterine in secondary infertility patients was 90. 48%（ 228 /252）,which was higher than primary infertility patients（ P〈0. 01）. The experimental group included FET patients who accepted HMIS before FET and patients who did not agree HMIS before FET were in the control group. There were no significant differences between the two groups in the type of infertility,causes of infertility,average age,average duration of infertility,the average number of graft failure,endometrial preparation program for FET,endometrium thickness on day of embryo transfer,number of transferred embryos; the embryo implantation rate and clinical pregnancy rate of the experimental group were significantly higher than those of control group（ P〈0. 01）. Conclusions： For patients with failed IVF / ICSI-ET,HMIS before the next cycle of IVF / ICSI-ET or FET can effectively improve the endometrial receptivity,embryo implantation rate and clinical pregnancy rate.