上海交通大学学报（医学版）

›› 2012, Vol. 32 ›› Issue (8): 992-.doi: 10.3969/j.issn.1674-8115.2012.08.007

• 专题报道（不孕不育症及辅助生殖技术） • 上一篇    下一篇

体外受精－胚胎移植中反复种植失败后宫腔镜检查的临床意义

陈平平1, 高敏芝1, 赵晓明1, 孙 赟1, 房素萍2, 茅 琳1   

  1. 1．上海交通大学 医学院附属仁济医院生殖医学科, 上海 200001； 2.上海计生所医院, 上海 200032
  • 出版日期:2012-08-28 发布日期:2012-08-29
  • 通讯作者: 赵晓明, 电子信箱: zhao_xiao_ming@hotmail.com； 高敏芝, 电子信箱: 328gao@sina.com。
  • 作者简介:陈平平（1987—）, 女, 硕士生；电子信箱: chenpipi1987@yahoo.com.cn。
  • 基金资助:

    上海交通大学“医工交叉研究基金”项目（YG2011MS42）

Clinical significance of hysteroscopy after repeated implantation failure in in vitro fertilization and embryo transfer

CHEN Ping-ping1, GAO Min-zhi1, ZHAO Xiao-ming1, SUN Yun1, FANG Su-ping2, MAO Lin1   

  1. 1.Department of Reproductive Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200001, China；2.Affiliated Hospital of Shanghai Institution of Planned Parenthood Research, Shanghai 200032, China
  • Online:2012-08-28 Published:2012-08-29
  • Supported by:

    Foundation from Shanghai Jiaotong University, YG2011MS42

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摘要：

目的 宫腔镜下观察反复种植失败（RIF）后妇女宫腔异常检出率和异常类型，评价RIF妇女再次体外受精－胚胎移植（IVFET）前行宫腔镜检查的临床意义。方法 回顾性分析197例既往IVF-ET失败≥2次者（RIF组）与176例行输卵管插管通液拟供精人工授精者（对照组）的宫腔镜检查结果，比较两组宫腔异常检出率和异常类型。结果 宫腔镜检查发现，RIF组宫腔异常检出率显著高于对照组（51.78%和28.98%，P<0.01）。RIF组宫腔异常类型较对照组更多，主要为内膜异常，包括息肉或息肉样增生（26.39%）和内膜炎（4.06%）；其次为宫腔形态异常，包括宫腔狭小（9.64%）和宫腔粘连（5.08%）。各年龄段RIF组患者的宫腔异常检出率均高于对照组，其中25~29岁和30~34岁年龄段的对照组与RIF组比较差异均有统计学意义（P<0.01，P<0.05）。Logistic回归分析发现，RIF病例类型（P=0.001，OR=2.320，95%CI：1.440~3.736）和年龄（P=0.039，OR=1.403，95%CI：1.016~1.935）是宫腔异常的危险因素，而不孕年限（P=0.747，OR=1.038，95%CI：0.827~1.303）不是宫腔异常的危险因素。RIF妇女中，原发不孕组与继发不孕组的宫腔异常检出率差异无统计学意义（P>0.05）；但原发不孕组的内膜息肉或息肉样增生检出率高于继发不孕组（31.45%和17.80%，P<0.05），宫腔粘连检出率低于继发不孕组（2.42%和9.59%，P<0.05）。结论 RIF妇女宫腔异常率显著高于正常妇女，宫腔异常的主要类型为内膜息肉和息肉样增生。向RIF妇女推荐宫腔镜检查和治疗以改善宫腔环境、提高内膜容受性是合理且必要的。建议RIF妇女再次接受ET前常规行宫腔镜检查。

关键词: 宫腔镜, 反复种植失败, 供精人工授精, 宫腔异常, 内膜容受性

Abstract:

Objective To investigate the clinical significance of hysteroscopy after repeated implantation failure (RIF) in in vitro fertilization and embryo transfer (IVF-ET). Methods The hysteroscopic results of 197 women with failure in IVF-ET for no less than two times (RIF group) and 176 women undergoing artificial insemination with donor semen (control group) were retrospectively analysed, and the incidences and types of abnormal hysteroscopic findings were compared between two groups. Results The incidence of abnormal hysteroscopic findings in RIF group was significantly higher than that in control group (51.78% vs 28.98%, P<0.01), and the types of abnormal hysteroscopic findings in RIF group were more than those in control group. The main types of abnormal hysteroscopic findings in RIF group were endometrial abnormalities (polypi and polypoid proliferation, 26.39%; endometritis, 4.06%) and abnormal shape of uterine cavity (uterine cavity narrowness, 9.64%; uterine cavity adhesion, 5.08%). The incidence of uterine cavity abnormalities of each age group in RIF group was higher than that in control group, especially for the age groups of 25 to 29 years and 30 to 34 years (P<0.01, P<0.05). Logistic regression analysis revealed that types of RIF (P=0.001, OR=2.320, 95%CI：1.440-3.736) and age (P=0.039, OR=1.403, 95%CI：1.016-1.935) were risk factors of uterine cavity abnormalities, while duration of infertility (P=0.747，OR=1.038，95%CI：0.827-1.303) was not risk factor of uterine cavity abnormalities. In women with RIF, there was no significant difference in the incidence of uterine cavity abnormalities between primary infertility group and secondary infertility group （P>0.05）, while the incidence of polypi and polypoid proliferation in primary infertility group was significantly higher than that in secondary infertility group （31.45% vs 17.80%，P<0.05）, and the incidence of uterine cavity adhesion in primary infertility group was significantly lower than that in secondary infertility group (2.42% vs 9.59%，P<0.05). Conclusion The incidence of uterine cavity abnormalities in women with RIF is significantly higher than that in normal women, and the main types of uterine cavity abnormalities are polypi and polypoid proliferation. Hysteroscopic examiation should be carried out in women with RIF to improve the environment of uterine cavity and endometrium receptivity. Women with RIF are advised to undergo hysteroscopy before receiving a second ET.

Key words: hysteroscopy, repeated implantation failure, artificial insemination by donor semen, abnormal uterine cavity, endometrial receptivity