子宫纵隔不孕症患者行宫腔镜子宫纵隔切除术后IVF/ICSI结局分析

IVF/ICSI Outcomes in Infertility Patients with Uterine Septum after Transcervical Resection of Septum

目的:探讨宫腔镜子宫纵隔切除术(transcervical resection of septum,TCRS)对子宫纵隔不孕症患者行体外受精(in vitro fertilization,IVF)/卵细胞质内单精子注射(intracytoplasmic sperm injection,ICSI)结局的影响。方法:回顾性分析并比较2013年1月—2020年7月在南京大学医学院附属鼓楼医院生殖医学中心进行IVF/ICSI的183例子宫纵隔不孕症患者的治疗结局。其中156例行TCRS后IVF/ICSI(TCRS组),而27例患者拒绝TCRS直接行IVF/ICSI(未行TCRS组)。结果:共有247个移植周期,其中新鲜胚胎移植周期100个,临床妊娠率64.0%,活产率49.0%;冻融胚胎移植周期147个,临床妊娠率51.0%,活产率40.1%。新鲜胚胎移植周期和冻融胚胎移植周期中TCRS组与未行TCRS组的胚胎种植率、临床妊娠率、流产率、早产率、活产率及单胎妊娠新生儿出生体质量比较,差异均无统计学意义(均P>0.05)。新鲜胚胎移植周期中,与TCRS组比较,未行TCRS组的双胎妊娠率高(77.8%vs.27.3%,P=0.006),分娩孕周小(P=0.049),新生儿出生体质量低(P=0.005);冻融胚胎移植周期中2组相关指标差异无统计学意义(均P>0.05)。结论:对于无不良妊娠史的子宫纵隔不孕症患者IVF/ICSI前可不行宫腔镜TCRS,为改善子宫纵隔不孕症患者的妊娠结局建议行单胚胎移植。

Objective:To analyze the clinical outcomes of in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI) treatment in those patients after transcervical resection of septum(TCRS).Methods:The data of183 patients with uterine septum who underwent IVF/ICSI in our Center from January 2013 to July 2020 were collected.The pregnancy outcomes of the patients treated by TCRS(TCRS group,156 cases) or no TCRS(unTCRS group,27 cases) were analyzed.Results:There were 247 embryo transfer cycles in total.The clinical pregnancy rate was 64.0% and the live birth rate 49.0% in fresh embryo transfer cycles.In frozen embryo transfer cycles,the clinical pregnancy rate was 51.0% and the live birth rate 40.1%.There were no significant differences between the two groups in the implantation rate,clinical pregnancy rate,spontaneous abortion rate,premature birth rate,live birth rate and birth weight of newborn with single pregnancy(all P>0.05).Compared with the TCRS group,the unTCRS group had higher rate of twin pregnancy(77.8% vs.27.3%,P=0.006),the smaller gestational week of delivery(P=0.049) and the lower newborn birth weight(P=0.005) in fresh embryo transfer cycles.There were no significant differences in above related indexes between the two groups in frozen embryo transfer cycles(all P>0.05).Conclusions:For infertility patients with uterine septum without abnormal pregnancy history,before IVF/ICSI,can be not treated by TCRS.Single embryo transfer is recommended to improve their clinical outcome.