先天性子宫畸形患者IVF/ICSI临床结局分析

IVF/ICSI outcome of patients with congenital uterine malformation

目的探讨先天性子宫畸形患者行体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)助孕后的临床结局及子宫畸形对患者生育能力的影响。方法收集我院2011年6月至2016年9月收治的年龄小于40岁、先天性子宫畸形患者91例(共119个周期)为子宫畸形组(畸形组),选取同期因输卵管因素不孕行IVF/ICSI治疗且子宫形态正常的834例患者(共1 037个周期)作为对照组。回顾性分析两组患者的一般资料、实验室指标及妊娠结局。并将畸形组患者按是否接受宫腹腔镜矫正手术分为两个亚组:畸形未手术组(99个周期)和畸形术后组(20个周期),比较两亚组和对照组的妊娠结局。结果畸形组和对照组两组患者的一般资料比较无显著性差异(P>0.05),Gn天数和Gn用量、HCG日内膜厚度和HCG日E2水平、获卵数、移植胚胎数、优质胚胎数间等比较亦无显著性差异(P>0.05)。畸形组每取卵周期累积妊娠率与对照组比较无显著性差异(P>0.05),但每周期累积活产率显著低于对照组(40.34%vs.51.01%),流产率显著高于对照组(34.25%vs.12.74%)(P<0.05);两组间早产率和双胎妊娠率比较无显著性差异(P>0.05),但畸形组的早产率呈上升趋势;两组的平均分娩孕周及平均新生儿体重比较亦无显著性差异(P>0.05)。畸形未手术组、畸形术后组和对照组3组间累积临床妊娠率、累积活产率、流产率、早产率及双胎妊娠率比较均无显著性差异(P>0.05)。两组均无畸形儿出生。结论先天性子宫畸形可降低IVF/ICSI助孕治疗的活产率,但对于轻度子宫畸形合并不孕的患者,在接受助孕治疗前,可暂不行矫正手术。

Objective ： To analyze the IVF/ICSI outcome of the patients with congenital uterine malformation.Methods ： The clinical data of 119 IVF/ICSI cycles in 91 patients less than 40 years old with congenital uterine anomalies treated in our hospital from June 2011 to September 2016 were collected as uterine malformation group,and 834 IVF/ICSI patients （1 037 cycles） with normal uterine morphology and fallopian tube factor at the same period were selected as the control group.The general characteristics,laboratory indicators and the pregnancy outcomes of the two groups were retrospectively analyzed and compared.Then the patients in the malformed group were subdivided into two subgroups according to whether they underwent laparoscopic or hysteroscopic surgery： malformed un-operated group （99 cycles） and malformed postoperative group （20 cycles）.The pregnancy outcomes of the two subgroups and the control group were compared.Results ： There were no significant differences in general characteristics,the duration and dosage of Gn administrated,endometrial thickness and E 2 level on HCG day,numbers of oocytes retrived,good quality embryos and embryos transferred,cumulative clinical pregnancy rate per oocyte retrieved cycle between the malformation group and control group （ P 〉0.05） ,while the patients with uterine malformation had significantly lower cumulative live birth rate per cycle （40.34% vs.51.01%）and significantly higher abortion rate（34.25% vs.12.74%）than control group （ P 〈0.05）.No congenital malformation neonate was found in both groups.There was no significant difference in preterm birth rate and twin pregnancy rate between the two groups （ P 〉0.05） ,but the premature rate of the malformation group showed an upward trend.There was no significant difference in the average gestational weeks and average neonatal weight between the two groups （ P 〉0.05） .There was no significant difference in cumulative clinical pregnancy rate,cumulative live birth rate,abortion rate,preterm birth rate and twin pregnancy rate among the malformed un-operative group,the malformation postoperative group and the control group （ P 〉0.05）.Conclusions ： Congenital uterine malformation reduces the live birth rate of IVF/ICSI,while infertile patients with mild uterine malformation cannot undergo corrective surgery before receiving assisted reproductive treatment.