辅助生殖技术中的阴道微生态及对妊娠结局的影响

The vaginal microecology in assisted reproductive technology and its effects on pregnancy outcome

目的通过观察辅助生殖技术中控制性超促排卵(COH)前后阴道微生态环境,探讨COH对阴道微生态的影响及阴道微生态对妊娠结局的影响。方法纳入行体外受精-胚胎移植(IVF-ET)周期第1周期长方案COH患者150例,在COH前和人绒毛膜促性腺激素(HCG)日2次行阴道微生态检查,比较阴道微生态变化对妊娠结局的影响。结果COH后阴道微生态失调者较COH前显著增加(15.3%vs32.0%,P<0.05);COH前已有阴道微生态异常者更容易发生微生态失调(26.8%vs60.9%,P<0.01);阴道微生态失调者生化妊娠率、临床妊娠率、种植率、活产率均降低,流产率增高,但差异无统计学意义(P>0.05)。结论COH可引起阴道微生态失调,这可能直接或间接改变胚胎种植环境而对妊娠结局产生一定程度的影响;可在HCG日对COH者行二次阴道微生态检查,并注意加强宣教及外阴清洁、护理,有助于改善妊娠结局。

Objective To observe the vaginal microecology before and after controlled ovarian hyperstimulation(COH) in assisted reproductive technology(ART),and to explore the effects of COH on vaginal microecology and the effects of vaginal microecology on pregnancy outcome. Methods A total of 150 patients who received IVF-ET were enrolled in this study. The vaginal microecology examination was performed twice before COH and on the day of HCG. The effects of vaginal microecology on pregnancy outcomes were observed and compared. Results The patients with vaginal microecological disorder after COH were significantly more than those before COH(15. 3% vs 32. 0%,P < 0. 05). The patients with vaginal microecological disorder before COH were more likely to be suffer from microecological disorder again after COH(26. 8% vs60. 9%,P < 0. 01). The biochemical pregnancy rate,clinical pregnancy rate,implantation rate,live birth rate were decreased and miscarriage rate was increased in patients with vaginal microecological disorder,but there were no significant differences(P > 0. 05). Conclusion COH can cause vaginal microecology disorder,which may directly or indirectly change the environment of embryo implantation and may have an impact on pregnancy outcome. Vaginal microecology examination can be performed on the day of HCG,and vulva cleaning and nursing should be focused,which may be helpful to improve pregnancy outcome.