有剖宫产史的不孕患者体外受精-胚胎移植的妊娠结局

Pregnancy Outcomes of IVF-ET in Infertile Patients With History of Cesarean Section

目的探讨有剖宫产手术史的不孕患者体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)的妊娠结局。方法回顾性分析2016年1~12月有剖宫产史的IVF-ET(n=215)资料,按照年龄1∶1匹配,选取有阴道分娩史但无剖宫产史IVF-ET(阴道分娩史组,n=215)、无分娩史IVF-ET(无分娩史组,n=215)作为对照组。3组年龄、基础卵巢储备及超促排卵过程用药量等差异均无统计学意义(P>0.05)。比较3组IVF-ET、妊娠及分娩结局。结果剖宫产史组临床妊娠率、双胎妊娠率较2个对照组更低[36.5%(62/170)vs.49.7%(81/163)vs.47.5%(76/160),χ^(2)=6.802,P=0.033;8.1%(5/62)vs.27.2%(22/81)vs.26.3%(20/76),χ^(2)=9.225,P=0.010]。3组移植周期率、胚胎种植率、流产率、异位妊娠率、足月产率、早产率、新生儿出生体重差异均无统计学意义(P>0.05)。根据移植胚胎数分为单胚胎移植、双胚胎移植,3组临床妊娠率、双胎妊娠率差异均无统计学意义(P>0.05)。结论有剖宫产手术史的不孕患者IVF-ET的胚胎种植率率、临床妊娠率与无剖宫产手术史者相近。

Objective To investigate the pregnancy outcome of in vitro fertilization and embryo transfer(IVF-ET)in infertile patients with a history of cesarean section.Methods A retrospective analysis was performed on IVF-ET patients with a history of cesarean section(cesarean section history group,n=215)in our hospital from January to December 2016.According to the age 1∶1 matching,IVF-ET patients with previous history of vaginal delivery but no history of cesarean section(vaginal delivery group,n=215),and IVF-ET patients with no history of delivery(no history of delivery group,n=215)were selected as the control groups.There were no statistically significant differences in age,basic ovarian reserve and drug dosage during hyperovulation among the 3 groups(P>0.05).The outcomes of IVF-ET,pregnancy and delivery were compared among the three groups.Results The clinical pregnancy rate and twin pregnancy rate in the cesarean section history group were significantly lower than those in the two control groups[36.5%(62/170)vs.49.7%(81/163)vs.47.5%(76/160),χ^(2)=6.802,P=0.033;8.1%(5/62)vs.27.2%(22/81)vs.26.3%(20/76),χ^(2)=9.225,P=0.010].There were no significant differences in the transplantation cycle rate,embryo implantation rate,abortion rate,ectopic pregnancy rate,full-term birth rate,premature delivery rate and newborn birth weight among the 3 groups(P>0.05).According to the number of embryos transferred,the three groups were divided into single embryo transfer(SET)and double embryo transfer(DET)to analysis.There were no significant differences in clinical pregnancy rate and twin pregnancy rate among the three groups(P>0.05).Conclusion The embryo implantation rate and clinical pregnancy rate of IVF-ET in infertile patients with a history of cesarean section were similar to those without cesarean section.