子宫发育异常合并不孕症的诊治策略

Clinical strategy of infertility combined with uterine malformation

子宫发育异常是女性生殖系统在胚胎6~20周间双侧副中肾管发育、融合和(或)吸收异常导致先天性子宫形态和功能异常的一系列表型谱。以纵隔子宫为代表的常见类型通常与反复流产、早产、胎位异常等产科并发症风险增加密切相关,但尚无足够证据支持其与原发不孕的相关性。除“无子宫”是明确的子宫性不孕因素外,其他类型的子宫发育异常往往均保有基本正常的生育力,在排除其他导致不孕的原因,且助孕失败的情况下再行子宫矫形术是审慎的做法。目前仅明确推荐对于反复流产和反复种植失败的患者施行宫腔镜子宫纵隔切除术。

Uterine malformation is a spectrum of congenital uterine morphological and functional anomalies caused by abnormal development,fusion,or(and)absorption of bilateral Mullerian ducts in the female reproductive system during the 6-20 weeks of the embryo.Common types represented by the septate uterus are often associated with an increased risk of obstetric complications such as recurrent miscarriage,preterm delivery,and fetal malpresentation,but there is no sufficient evidence to support its association with primary infertility.With the exception of"uterine agenesis"as a definite factor of uterine infertility,other types of uterine malformation tend to maintain good reproductive outcome,and it is prudent to rule out the nonuterine causes of infertility before metroplasty is profermed.Hysteroscopic septal incision is currently only recommended for patients with recurrent miscarriages and recurrent implantation failures.