反复着床失败患者的临床病例对照研究

Clinical case-control study in patients with recurrent implantation failure

目的回顾分析在行体外授精胚胎移植(IVF-ET)助孕过程中反复着床失败(RIF)患者的临床资料,旨在发现反复着床失败的高危因素,以期早期识别并降低反复着床失败的发生率。方法选取2015年-2016年诊断为反复着床失败患者196例作为RIF组,并选取与RIF组患者同期行第一次IVF助孕且成功获得妊娠的患者392例作为正常对照组。分析两组患者的基本资料、不孕病因及第一次IVF周期的相关资料。此外,根据患者的年龄将以上统计资料进行年龄的分层分析。结果患者丈夫年龄和子宫内膜异位症是反复着床失败的危险因素,而总2PN率、优质胚胎率及A型内膜则是反复着床失败的保护因素。年龄分层分析显示女方年龄≥35岁组中丈夫年龄、ICSI-2PN率在RIF组和对照组间有统计学差异。30≤年龄<35岁组中无排卵性不孕、男方因素、优质胚胎数、总2PN率、IVF-2PN率、ICSI-2PN率及优质胚胎率在两组间有统计学差异。而年龄<30岁组中雄激素水平、内膜厚度、获卵总数及2PN数在两组间有统计学差异。结论不孕患者的丈夫年龄越大发生反复着床失败的风险越高;合并子宫内膜异位症的不孕患者更容易发生反复着床失败,而受精率高、胚胎质量好及HCG日为A型内膜形态的的患者行IVF助孕的成功率高。此外,应根据患者的年龄进行分层化管理。

Objective In order to find the risk factors of recurrent implantation failure and to reduce the incidence of recurrent implantation failure by retrospective analysis of the clinical data of the patients with recurrent implantation failure.Methods 196 cases who were diagnosed as recurrent implantation failure during 2015-2016,and 392 patients with successful pregnancy of their first IVF cycle which was preformed at the same month with recurrent implantation failure patients were selected as the control group.The clinical data of the two groups were analyzed,including basic information,the cause of infertility and the first IVF cycle-related information.Besides,according to patients′age,we analyze the clinical data in each group.Results Patients′husband age and endometriosis are risk factors for recurrent implantation failure,while the 2PN rate,the rate of good quality embryo and A pattern of the endometrium are protective factors for recurrent implantation failure.Analysis on Stratification of Age revealed that the age of the husband and ISCI-2PN rate had statistical significance in Group A,and anovulatory infertility,male factors,high quality embryos,total 2PN rate,IVF-2PN rate,ICSI-2PN rate and high quality embryo rate were significantly different in Group B,and there were significant differences in androgen levels,endometrial thickness,total oocytes count and 2PN numbers in Group C.Conclusion The higher the age of the husband,the higher the risk of recurrent implantation failure,and the infertile patients combined with endometriosis are prone to recurrent implantation failure.While the success rate of IVF assisted pregnancy was high in patients with high fertilization rate,good embryo quality and A pattern endometrium.In addition,stratification management according to the patients′age should be used.