首次体外受精胚胎移植周期前宫腔镜检查对周期结局的影响

Effects of pre-cycle hysteroscopic examination on outcome of the first in vitro fertilization and embryo transfer cycle

目的 观察首次体外受精胚胎移植周期前宫腔镜检查对患者周期结局的影响,并探讨获益最大的不孕症人群,以期为临床工作提供参考.方法 选取行首次体外受精胚胎移植的不孕症患者715例,根据移植周期前有无行宫腔镜检查将患者分为两组,N组374例,未行宫腔镜检查;D组341例,行宫腔镜检查.N组与D组根据不孕的病因[输卵管因素不孕(A)、排卵障碍不孕(B)、不明原因不孕(C)、子宫内膜异位症不孕(D)、男性不育(E)]各又分5个亚组,分别为NA组197例、NB组49例、NC组56例、ND组24例、NE组48例和DA组190例、DB组52例、DC组50例、DD组23例、DE组26例.比较N组患者与D组患者临床特征与胚胎种植率、临床妊娠率;比较相同不孕病因的亚组间胚胎种植率、临床妊娠率.结果 N组患者与D组患者年龄、不孕年限、原发不孕与继发不孕比例、促性腺激素使用天数、促性腺激素用量、获卵数、移植日子宫内膜厚度、移植胚胎数等比较差异均无统计学意义(均P>0.05).D组患者胚胎种植率、临床妊娠率均高于N组患者,差异均有统计学意义(均P<0.05).DA组患者胚胎种植率、临床妊娠率均高于NA组(均P<0.05).NB组与DB组、NC组与DC组、ND组与DD组、NE组与DE组间胚胎种植率、临床妊娠率比较差异均无统计学意义(均P>0.05).结论 输卵管因素不孕患者首次体外受精胚胎移植周期前应常规行宫腔镜检查,以利于提高辅助生殖技术治疗成功率.

Objective To investigate the effect of pre-cycle hysteroscopic examination on the outcome of the first in vitro fertilization and embryo transfer(IVF-ET)cycle.Methods Seven hundred and fifteen infertile patients who underwent the first IVF-ET cycle were enrolled in the study.There were 341 cases receiving pre-cycle hysteroscopic examinations(D group)and 374 cases without pre-cycle hysteroscopic examination(N group).Group N and group D were further divided into 5 subgroups according to the causes of infertility:subgroup A:tubal factor infertility,subgroup B:ovulation disorder infertility,subgroup C:unexplained infertility,subgroup D:endometriosis infertility and subgroup E:male infertility.There were 197 cases in NA subgroup,49 cases in NB subgroup,56 cases in NC subgroup,24 cases in ND subgroup,48 cases in NE subgroup;190 cases in DA subgroup,52 cases in DB subgroup,50 cases in DC subgroup,23 cases in DD subgroup and 26 cases in DE subgroup.The clinical characteristics,embryo implantation rate and clinical pregnancy rate were compared between N and D groups and between corresponding subgroups.Results There were no significant differences between group N and group D in age,infertility years,ratio of primary infertility to secondary infertility,days of use of gonadotropin,dosage of gonadotropin,number of eggs obtained,intrauterine thickness and number of embryos transferred(all P>0.05).The rates of embryo implantation and clinical pregnancy in group D were higher than those in group N(both P<0.05).The rates of embryo implantation and clinical pregnancy in DA subgroup were higher than those in NA subgroup(both P<0.05).There were no significant differences in the rates of embryo implantation and clinical pregnancy between NB and DB subgroup,NC and DC subgroups,ND and DD subgroups,NE and DE subgroups(all P>0.05).Conclusion Hysteroscopic examination should be performed routinely before the first IVF-ET cycle in patients with tubal infertility to improve the success rate of assisted reproductive technology.