妊娠滋养细胞疾病史的不孕患者体外受精/卵胞质内单精子显微注射结局分析

Clinical outcomes of in vitro fertilization/intracytoplasmic sperm injection treatment in infertility women with a history of gestational trophoblastic disease

目的探讨既往患妊娠滋养细胞疾病(GTD)对不孕患者行体外受精/卵胞质内单精子显微注射(IVF/ICSI)治疗的临床结局影响。方法回顾性分析43名有GTD史的继发不孕患者(研究组)的临床资料,并根据年龄、不孕年限、不孕原因及促排卵方案1︰2匹配86名既往无GTD史的继发不孕患者作为对照组,比较两组间的IVF/ICSI临床结局。研究组再根据既往GTD的治疗方法分为单纯清宫组(A亚组,n=32)和清宫联合化疗组(B亚组,n=11)。结果研究组与对照组在获卵数、正常受精数、异常受精数及可用胚胎数上组间差异均无统计学意义(P>0.05)。研究组移植日内膜厚度[(9.2±2.1)mm]明显低于对照组[(10.3±2.0)mm,P=0.002],移植后的生化妊娠率(31.7%)和继续妊娠率(18.3%)都显著低于对照组(47.5%,37.6%),差异有统计学意义(P=0.007)。但研究组的分娩孕周及新生儿体质量与对照组差异无统计学意义。A亚组和B亚组的可用胚胎数及继续妊娠率组间差异均无统计学意义(P>0.05)。结论既往GTD史的继发不孕患者应用IVF/ICSI治疗的过程中,可获得与无GTD史的患者相似的正常受精数及可用胚胎数。但由于移植日内膜厚度更薄,故移植后的妊娠率低于无GTD史的患者。

Objective To explore the effect of a history of gestational trophoblastic disease （GTD） on the clinical outcomes of in vitro fertilization/intracytoplasmic sperm injection （IVF/ICSI） treatments in infertility women. Methods This retrospective study included 43 patients with a history of GTD as study group and 86 patients 1 ： 2 matched by age, duration of infertility, cause of infertility and same ovarian stimulation protocol as control group. The patients in study group were divided into subgroup A （uterine curettage group, n=32） and subgroup B （uterine curettage combined with chemotherapy group, n=11） according to the therapy received, The characteristics of ovarian stimulation and outcomes of embryos and pregnancy were compared. Results Study group had similar retrieved oocytes, normal fertilized oocytes, abnormal fertilized oocytes and viable embryos compared with control group （P〉0.05）. However, there was a significant difference in thickness of the endometrium between study group [（9.2±2.1） mm] and control group [（10.3±2.0） ram, P=-0.002]. The biochemical pregnancy rate and ongoing pregnancy rate in study group （31.7%, 18.3%） were significantly lower than those in control group （47.5%, 37.6%, P=0.007）. The birth outcomes were not different between the two groups. And there was no significant difference between subgroups A and B. Conclusion Patients with a history of GTD can present with a similar number of normal fertilized oocytes and number of viable embryos. However, patients with a history of GTD may have a thinner endometrium, thus resulting in lower ongoing pregnancy rate.