体外受精-胚胎移植中单角子宫并卵巢异位2例报道并文献复习

Two cases of unicornuate uterus with ectopic ovary in IVF-ET and literature review

目的探讨体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)中单角子宫并卵巢异位的临床处理策略。方法回顾性分析2例罕见的行IVF-ET的单角子宫合并卵巢异位患者的临床资料,并进行相关文献复习。结果2例左侧单角子宫合并原发不孕患者阴道超声提示右侧卵巢未探及,进一步行腹部核磁共振和腹部超声提示右侧卵巢腹腔异位。病例1在超促排卵过程中诉右侧腰部胀痛,血清雌激素水平和阴道超声下左侧卵泡数量不一致,继而阴道联合腹部超声同步监测卵泡发育,给予经腹部及阴道联合采卵,经冻胚移植后成功妊娠并于36周分娩。病例2亦在超促排卵过程中同步监测两侧卵巢卵泡发育,经阴道联合腹部采卵后获得2枚囊胚冻存,解冻单囊胚移植后自然流产。结论卵巢异位多无明显临床表现,极易被漏诊。对于单角子宫行辅助生殖技术助孕的患者,如阴道超声未能探及单/双侧卵巢,应进一步行腹部超声或核磁共振检查有无卵巢异位;如确诊合并卵巢异位,患者在超促排卵过程中应同步监测双侧卵巢卵泡发育,采用经阴道联合腹部采卵,最大程度增加患者的获卵率和妊娠机会。

Objective To summarize the management of unicornuate uterus with ectopic ovary during in vitro fertilization and embryo transfer(IVF-ET).Methods The clinical data of 2 rare cases of uniangular uterus with ectopic ovary undergoing IVF-ET were retrospectively analyzed and the related literatures were reviewed.Results Two patients were diagnosed as unicornuate uterus with unilateral ovary missing by vaginal ultrasound,subsequent abdominal ultrasound and magnetic resonance imaging(MRI)results indicated follicular structure in the peritoneal area,suggesting ectopic ovary.Case 1 showed flank pain as well as discrepancy between serum estradiol level and follicle numbers during ovarian hyperstimulation.The patient received trans-abdominal combined with trans-vaginal oocyte retrieval and successfully delivered a healthy baby at 36 weeks by transferring frozen blastocyst embryo.Case 2 was diagnosed as unicornuate uterus with lateral ectopic ovary by abdominal ultrasound before IVF treatment.We performed synchronized monitoring of bilateral ovarian follicular development and oocytes retrieval by transabdominal and transvaginal ultrasound,and then the two blastocysts were cryopreserved.However,the patient experienced spontaneous abortion following single frozen-thawed blastocyst transfer.Conclusion Ectopic ovaries present no obvious clinical manifestation and is easy to be ignored in diagnosis.For patients with unicornuate uterus treated by assisted reproductive technology,if vaginal ultrasound fails to detect ovary,we should further perform abdominal ultrasound or MRI to screen for ectopic ovary.If diagnosed with ectopic ovary,the patients should simultaneously be monitored the follicullar development of bilateral ovaries during the process of ovarian hyperstimulation and adopt both transabdominal and transvaginal ultrasound-guided follicular aspiration to maximize the numbers of oocyte and pregnancy chance.