体外受精/卵胞浆内单精子注射-胚胎移植后稽留流产采用药物流产和清宫术效果比较

Comparison of medical abortion and surgical abortion in the management of missed abortion after in vitro fertilization/intracytoplasmic sperm injection-embryo transfer

目的 比较体外受精/卵胞浆内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection-embryo transfer, IVF/ICSI-ET)后发生稽留流产时,药物流产和清宫术两种治疗方法的流产效果及其对后续胚胎移植妊娠结局的影响。方法 研究对象为2016年1月至2017年1月在山东大学附属生殖医院进行IVF/ICSI-ET治疗、妊娠周数均小于13周的稽留流产并于山东大学附属生殖医院行流产治疗的患者,按照随机数字表法分为药物流产组(n=134)和清宫组(n=130)。对患者进行药物流产或者清宫治疗,比较两组患者的流产成功率、流产前后子宫内膜厚度变化和流产后进行第一次胚胎移植的妊娠结局等指标。结果 行清宫术患者的流产成功率高于行药物流产患者(99.23%vs 85.35%,P<0.001)。清宫组流产当次胚胎移植前人绒毛膜促性腺激素(human chorionic gonadotropin, HCG)日子宫内膜厚度略高于药物流产组[(1.01±0.19)cm vs(1.06±0.20)cm,P=0.040];清宫组的流产前、后两次胚胎移植前的内膜厚度差值高于药物流产组[(-0.01±0.17)cm vs(0.06±0.17)cm,P=0.008]。两组在流产后进行第一次胚胎移植的妊娠结局差异均无统计学意义。结论 孕13周内的IVF/ICSI后稽留流产,清宫流产疗效高于药物流产,但药物流产可能比清宫更有利于保护子宫内膜;两种治疗方法对后续第一次胚胎移植的妊娠结局无明显影响。

Objective To compare the efficacy of medical abortion and surgical abortion in the management of missed abortion after in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)and their effects on the pregnancy outcomes of subsequent embryo transfer.Methods Patients with missed abortion after IVF/ICSI-ET with gestation weeks less than 13 weeks,treated in the Reproductive Hospital Affiliated to Shandong University during Jan.2016 and Jan.2017 were selected and divided into medical group(n=134)and surgical group(n=130)according to random number table method.The success rate of abortion,changes of endometrial thickness before and after abortion,and the pregnancy outcomes of the first embryo transfer after abortion were observed.Results The success rate of surgiacal abortion was significantly higher than that of medical abortion(99.23%vs.85.35%,P<0.001).The endometrial thickness before embryo transfer on the human chorionic gonadotropin(HCG)day was higher in the surgical group than in the medical group[(1.01±0.19)cm vs.(1.06±0.20)cm,P=0.040].Furthermore,there was a great difference in endometrial thickness before and after embryo transfer in the surgical group compared to the medical group[(-0.01±0.17)cm vs.(0.06±0.17)cm,P=0.008].There were no significant differences in the pregnancy outcomes following the first embryo transfer after abortion between the two groups.Conclusion For missed abortion after IVF/ICSI within 13 weeks of gestation,the efficacy of surgical abortion is higher than that of medical abortion.However,medicine may be more beneficial to endometrial preservation than surgery.The two treatments have no significant impact on the pregnancy outcomes following the first embryo transfer.