不明原因不孕症中不容忽略的宫腔因素

The role of uterine cavity factors in unexplained infertility

不明原因不孕症(UI)指夫妇有规律性生活且未采取任何避孕措施1年未孕,并经过常规的3大不孕因素筛查而未能明确不孕病因的不孕状态。UI是排除性诊断,只是排除了精液、排卵和输卵管通畅性的问题,并非没有原因。受孕的过程极其复杂精妙,受到多个环节的影响,而宫腔作为胚胎着床的部位,是不容忽视的重要因素之一。目前研究认为,子宫动脉血流、子宫肌瘤、子宫内膜息肉、子宫内膜炎等均对子宫内膜容受性产生影响。在UI中,这些因素同样重要,但阴道超声的局限性使这些问题未被有效评估及处理。现就临床工作中常被忽视而又与UI相关的宫腔因素作一综述,分析其在UI中的作用,以期在准确诊断UI的基础上增加患者的妊娠概率。

Unexplained infertility(UI) refers to a condition in which a couple has a regular life, hasn′t gotten pregnant for one year without using any contraception, and has undergone a standard screening test for three factors that cause infertility. UI is an exclusionary diagnosis that only rules out problems with semen, ovulation, and fallopian tube patency, not without cause. The process of conception is extremely complex and delicate, which is affected by many links. As the site of embryo implantation, the uterine cavity is one of the important factors that cannot be ignored. Current studies suggest that uterine artery blood flow, uterine fibroids, endometrial polyps and endometritis all affect endometrial receptivity. These factors are equally important in the UI, but the limitations of vaginal ultrasound prevent them from being effectively evaluated and addressed. In this paper, the factors of uterine cavity associated with UI, which are often neglected in clinical work, are reviewed, and their roles in UI are analyzed in order to increase the pregnancy probability of patients on the basis of accurate diagnosis of UI.