宫腔异常治疗对反复种植失败患者助孕结局的影响

Management of the uterine abnormalities on the reproductive outcomes in women with repeated implantation failure

目的探讨反复种植失败患者宫腔异常治疗后再次胚胎移植的生殖结局。方法采用回顾性病例对照研究分析2017年1月1日至2021年3月31日期间于天津医科大学总医院妇产科生殖医学中心接受宫腔镜检查的89例反复种植失败患者的临床资料,根据宫腔镜镜下诊断及内膜病理,将患者分为正常宫腔组(n=38)以及异常宫腔组(n=51)。异常宫腔组患者接受相应的治疗后,所有患者再次接受胚胎移植,比较两组患者再次胚胎移植的生殖结局。结果89例反复种植失败患者中,宫腔异常的发生率为57.30%(51/89),其中慢性子宫内膜炎的发生率为39.33%(35/89),是宫腔异常最常见的类型。38例正常宫腔组患者,再次胚胎移植有16例患者获得临床妊娠,51例异常宫腔组中24例患者获得临床妊娠。两组之间胚胎种植率、临床妊娠率和异位妊娠率差异均无统计学意义(均P>0.05)。正常宫腔组再次胚胎移植的早期自然流产率[37.50%(6/16)]显著高于异常宫腔组[8.33%(2/24),P=0.042]。结论反复种植失败患者宫腔异常以原发不孕患者为主。异常宫腔患者经治疗后可获得与正常宫腔相同的临床妊娠率。因此,建议反复种植失败患者常规行宫腔镜检查评估宫腔环境。

Objective To analyze the reproductive outcomes of the subsequent embryo transfer(ET)cycles in women with repeated implantation failure(RIF)after the management of uterine cavity abnormalities.Methods This was a retrospective case-control study.The clinical data of 89 patients with repeated implantation failure who underwent hysteroscopy at Reproductive Medicine Center of the Department of Obstetrics and Gynecology,Tianjin Medical University General Hospital from January 1,2017 to March 31,2021 were analyzed.The patients were assigned to a normal uterine cavity(UC)group(n=38)and an abnormal UC group(n=51)according to hysteroscopic examination and endometrial biopsy results.Women in the abnormal UC group received relevant treatments,and all patients received the embryo transfer again.The reproductive outcomes were compared between the two groups in the subsequent ET cycles.Results The prevalence of uterine abnormalities was 57.30%(51/89)in women with RIF.Chronic endometritis accounted for the highest incidence 39.33%(35/89).Among 38 women in normal UC group,16 women got clinical pregnancy in the subsequent ET cycles,and 24 women in 51 got clinical pregnancy in the abnormal UC group.There were no differences in the implantation rate,the clinical pregnancy rate,and the ectopic pregnancy rate between the two groups(all P>0.05).The early abortion rate was significantly higher in the normal UC group[37.50%(6/16)]than in the abnormal UC group[8.33%(2/24),P=0.042].Conclusion The uterine abnormalities mainly occurred in women with primary infertility.The clinical pregnancy rate of women after correction of uterine abnormalities was similar to those women with normal UC.Hysteroscopy was advised to performed routinely to evaluate the uterine environment in women with RIF.