辅助生殖患者宫腔粘连术后应用人工周期促内膜修复的疗效及对生育结局的影响

目的评价17-β雌二醇用于辅助生殖患者宫腔粘连术后促子宫内膜修复的效果及对生育结局的影响。方法 429例拟行体外受精-胚胎移植(IVF-ET)患者,因宫腔粘连经宫腔镜下行宫腔粘连分离术和放置宫内节育器术,215例术后应用17-β雌二醇+地屈孕酮行周期治疗(雌二醇2mg bid)2周期(实验组),214例不行周期治疗(对照组)。所有病例定期随诊,治疗结束后再行宫腔镜检查探查宫腔情况并取出宫内节育器,再行胚胎移植,随访治疗疗效及妊娠结局。结果实验组的宫腔镜治疗治愈率明显较对照组高,X2=-3.16,p=0.002,实验组术后胚胎移植临床妊娠率也明显较对照组高X2=-2.75,p=0.006。结论宫腔粘连术后采用17-β雌二醇周期治疗,不但有利于宫腔形态的恢复及内膜的修复,而且可以提高内膜的容受性,明显改善妊娠结局。

Efficiency and pregnancy outcome of using artificial cycle after hysteroscopic treatment of intrauterine adhesion for patients undergoing in vitro fertilization and embryo transfer

Objective： To evaluate the effects and the pregnancy outcome of using artificial cycle after hysteroscopic adhesiolysis. Methods： A total of 429 patients were inserted an intrauterine device（IUD）for the patients treated with hysteroscopic adhesiolysis. Among them, 215 patients were treated with 17-β estradiol（2mg, bid）and dydrogesterone for two months（treatment group）,and 214 patients were not treated with hormone（control group）. All patients were followed up. IUDs were taken out after treatment when the second hysteroscopy was performed. Then all patients underwent in vitro fertilization and embryo transfer（IVF-ET）. Results： The cure rate of the hysteroscopic treatment in treatment group was significantly higher than the control group（X2=3.16,P=02 002）. The clinical pregnancy rate after embryo transfer in treatment group was significantly higher than the control group（X2=-2. 75,P=0. 006）. Conclusions： 17β estradiol used in intrauterine adhesion after surgery not only promotes the recovery of uterine morphology and endometrial repair, but also increases the receptivity of the endometrium, to improve pregnancy outcomes