53例IVF-ET失败者的宫内膜病理组织学探讨

目的:探讨IVF-ET失败患者的宫内膜组织学改变及对IVF-ET的影响.方法:对53例IVF-ET失败者的临床资料、宫腔镜检查的镜下改变及病理组织学改变进行分析.结果:宫内膜组织形态学异常8例(宫内膜息肉6例,结核性子宫内膜炎2例),宫内膜组织功能性异常4例(无排卵性宫内膜3例,混合性宫内膜1例),异常者12例,占全部病例的22.64%.结论:子宫内膜组织形态学异常和功能性异常是IVF-ET失败的一个重要原因.用宫腔镜作IVF-ET术后随访检查,便于对异常子宫内膜进行必要的治疗,恢复子宫内膜的正常功能,可能是提高IVF-ET临床妊娠率的重要方法之一.     

宫腔镜手术治疗子宫内膜息肉的临床分析

目的　探讨宫腔镜手术治疗子宫内膜息肉的临床效果。方法　因子宫内膜息肉行各类宫腔镜手术 10 9例 ,其中绝经后子宫内膜息肉 15例、生育期子宫内膜息肉 94例。 10 9例中合并月经紊乱 84例、贫血 34例、痛经 16例、原发不孕 3例、继发不孕 2例。患者年龄 2 6～ 73岁 ,平均 (45± 9)岁 ;随访时间 3～ 2 2个月 ,平均 (12± 5 )个月。月经紊乱者在术前和术后分别填写月经失血图以评估月经血量。结果　 10 9例中 ,单纯息肉切除 35例 ,息肉切除同时浅层内膜切除 9例 ,息肉切除同时内膜切除 6 3例 ,息肉切除同时内膜剥除 2例。 84例月经紊乱者术后闭经 14例、阴道点滴出血 2 6例 ,其余 4 4例月经血量均较术前减少。 34例术前贫血患者 ,术后 1个月血红蛋白即恢复正常。 16例痛经者术后 7例症状消失、7例缓解、2例加重。 5例不孕者术后 4例妊娠。 15例绝经后患者术后无异常出血。结论　有月经改变且无生育要求者 ,息肉切除同时应行子宫内膜电切术 ,可避免息肉复发 ;需保留生育功能的患者 ,可行单纯息肉切除 ,如合并内膜息肉样增生 ,应同时行浅层内膜切除 ;绝经后患者 ,可行单纯息肉切除 ,如合并内膜息肉样增生 ,应同时行子宫内膜剥除。     

宫腔镜下不同手术方式治疗子宫内膜息肉的临床疗效观察

目的探讨宫腔镜下不同手术方式治疗子宫内膜息肉的疗效。方法对不同年龄和不同生育要求的子宫内膜息肉患者327例,分别行子宫内膜息肉切除+子宫内膜汽化电切术(A组,53例);子宫内膜息肉切除+子宫内膜电切术(B组,175例);子宫内膜息肉切除+息肉旁浅层内膜切除术(C组,54例,要求保留生育功能者);子宫内膜息肉切除+子宫内膜电凝术(D组,45例,绝经后患者)。结果手术时间:A组(15·1±0·8)s,B组(19·7±0·7)s,C组(20·9±0·7)s,D组(22·1±0·8)s,A组平均手术时间与其他3组比较,差异有统计学意义(P<0·01);术后子宫内膜息肉复发率:A、D组为0,B组为1·7%(3/175),C组为7·4%(4/54),C组术后复发率与其他3组分别比较,差异均有统计学意义(P<0·05);C组术后无闭经者,但术后息肉复发率高于其他3组,C组中有14例术后5~23个月妊娠。结论宫腔镜下不同手术方式治疗子宫内膜息肉的临床疗效无明显差异,但子宫内膜息肉切除+息肉旁浅层内膜切除术后复发率高;应根据患者年龄、生育要求等选择适宜的宫腔镜下手术方式。     

子宫内膜息肉的宫腔镜检查——附158例分析

目的:探讨子宫内膜息肉行宫腔镜诊治的特性。方法:回顾我院2000-2002年妇科门诊158例子宫内膜息肉行宫腔镜的临床和病理资料。结果:158例中,术后病理证实是息肉98例,黏膜下肌瘤4例,恶性肿瘤4例(内膜腺癌3例,内膜间质肉瘤1例),结核1例,息肉状腺肌病1例,子宫内膜增生过长9例(其中7例为简单型增生过长,1例为复杂型增生过长,1例为复杂型伴不典型增生过长)。结论:子宫内膜息肉大多是良性病变,但也不能排除恶变或恶性肿瘤的息肉样变,而宫腔镜是直视下的手术,可尽早发现病变,避免病灶遗漏。     

宫腔镜手术治疗子宫内膜息肉的临床应用

目的　探讨采用宫腔镜电切术治疗子宫内膜息肉的可行性。方法　 2 0 0 0年 1月至 2 0 0 2年 12月施行宫腔镜电切除术治疗子宫内膜息肉 6 7例 ,且行术后定期随访。结果　采用宫腔镜电切术治疗子宫内膜息肉 ,手术时间 ( 19 39± 0 4 8)min ,出血量 ( 33 5 7± 0 6 8)mL。术后月经量明显减少者 4 1例 ( 6 1 19% ) ,无术中、术后并发症 ,降低了手术的风险系数 ,随访无复发。结论　宫腔镜电切术是治疗子宫内膜息肉的一种较好的手术方式。     

宫腔镜在诊断子宫内膜癌及癌前病变中的价值

目的 探讨宫腔镜检查对子宫内膜癌和子宫内膜癌前病变的诊断价值。方法 回顾分析1994年4月至1999年2月206例具有临床症状伴子宫内膜癌高危因素行宫腔镜检查病列。结果 宫腔镜诊断子宫内膜癌及可疑癌37例（18.0%）,经病理证实为癌者22例（10.7%）,19例进行了手术,术后病理证实宫颈管受侵4例,未受侵15例,与之相比,手术前宫镜诊断符合率为94.7%。术中腹水细胞学检查15例,阴性13例,阳性1例,可疑1例。206例中经病理证实I～Ⅲ级非典型增生12例,而宫腔镜下诊断为可疑癌4例,增生4例,正常或萎缩子宫内膜3例,内膜结核1例。结论 宫腔镜检查直观病灶,准确活检,适用于早期诊断,同时明确病灶部位和范围,提高宫颈管受侵与否的诊断率,但是宫腔镜下难以区别各类型子宫内膜增生性质。     

宫腔镜对诊断子宫内膜癌的价值

目的 探讨宫腔镜检查对子宫内膜癌和子宫内膜增生的诊断价值。方法 对206例具有临床症状伴子宫内膜高危因素者行宫腔镜检查的结果进行回顾性分析。结果 宫腔镜下诊断为子宫内膜癌及可疑癌共37例(18.6％),经病理证实为子宫内膜癌22例,其中19例进行了手术,术后病理报告宫颈管未受侵15例,受侵4例,与术前宫腔镜诊断符合率94.7％。术中腹水细胞学检查阴性13例,阳性1例,可疑1例。206例中经病理证实Ⅰ～Ⅲ级非典型增生12例,宫腔镜诊断分别为:可疑癌4例,子宫内膜增生3例,正常或萎缩宫内膜4例,内膜结核1例。结论:宫腔镜检查直观病灶,准确定位活检,尤其适用于早期诊断。另外宫腔镜检查能够明确病灶部位和范围,提高宫颈管术前是否受侵的诊断率。     

宫腔镜检查IVF-ET不同妊娠结局的宫腔情况比较和再次妊娠结局分析

目的:观察体外受精-胚胎移植(IVF-ET)不同妊娠结局的宫腔情况以及对异常宫腔患者治疗后的再妊娠情况.方法:回顾性分析行宫腔镜检查的582例IVF-ET病例,A组IVF-ET周期前常规宫腔镜检查223例,B组ET后发生异位妊娠18例,C组1次或多次ET未孕225例,D组ET后早期自然流产116例,B、C、D组不良妊娠结局发生后均做宫腔镜检查.比较4组宫腔镜检查的结果,并对发现宫腔异常者进行相应的治疗,观察治疗后的IVF-ET妊娠结局.结果:A组宫腔镜检查宫腔异常率低于B、C、D组(P＜0.05),D组中宫腔粘连发生率显著高于A、B、C组(P＜0.01).异常宫腔经治疗后妊娠率46.45％,异位妊娠率3.53％,早孕自然流产率12.94％.结论:对于IVF-ET助孕发生不良妊娠结局的患者,应将宫腔镜检查列为IVF-ET前的常规检查,以提高重复周期的临床妊娠率和着床率,进而提高活胎分娩率.     

不孕患者子宫内膜息肉的宫腔镜诊治临床分析

目的:探讨不孕患者子宫内膜息肉(EP)发生的相关因素及宫腔镜下EP清除术对助孕效果的影响。方法:接受宫腔镜检查的不孕患者855例,其中EP患者202例(EP组),宫腔正常者653例(对照组)。分析年龄、体质量指数、不孕年限、不孕类型及合并症等与EP发生的相关性;采用宫腔镜术联合药物(三联疗法)治疗,分析术后助孕效果。结果:EP发病率为23.6%,原发不孕、不孕年限>5年者EP发病率增高,EP患者合并子宫内膜异位症、子宫肌瘤、月经稀发几率明显增高(P<0.05);患者接受"三联疗法"治疗后,经助孕后临床妊娠率与对照组比无差异(P>0.05)。结论:宫腔镜手术有助于提高EP检出率,联合药物治疗的"三联疗法"是治疗EP的有效方法。     

阴道超声和宫腔镜检查对不孕患者子宫内膜病变的诊断价值

目的探讨阴道超声和宫腔镜检查对不孕患者子宫内膜病变的诊断价值。方法分析2001年2月至2004年7月山东省立医院、烟台毓璜顶医院首次体外受精与胚胎移植(IVFET)部分资料。对IVFET前自然周期超声监测内膜回声异常的52例患者,行宫腔镜检查(研究组Ⅰ),与超声检查内膜正常者(对照组Ⅰ,22例)比较。超声检查内膜正常者进入IVF周期后26例出现异常回声(研究组Ⅱ),IVF后宫腔镜检查,与IVF周期未发现内膜异常回声的,IVFET失败的患者(对照组Ⅱ,32例)比较。结果自然周期超声发现的异常内膜,经宫腔镜确诊(研究组Ⅰ)为78.84%,对照组Ⅰ为9.09%,两组比较差异有非常显著性意义(P<0.01)。促超排卵周期超声发现的异常内膜,IVF后宫腔镜确诊(研究组Ⅱ)为11.54%,对照组Ⅱ为12.50%,两组比较差异无显著性意义(P>0.05)。结论自然周期超声和宫腔镜检查是发现内膜病变的重要方法;超排卵周期超声发现的内膜异常,与内膜对激素的超反应有关,宫腔镜对这种内膜病变的诊断价值有待深入研究。     

Hysteroscopy in a program of in vitro fertilization

Two hundred twenty-four women underwent hysteroscopic evaluation without anesthesia after at least two failed attempts of in vitro fertilization and embryo transfer. One hundred fifty-three (68%) women were diagnosed as having mechanical infertility, and abnormal hysteroscopic findings were observed in 32 (21%). Forty-one women were diagnosed as having unexplained infer-tility (18%) and six (15%) had abnormal findings with hysteroscopy. Of the 30 couples who entered the in vitro fertilization regimen program because of male infertility, 4 (13%) had abnormal findings. The overall rate of abnormal findings was 19%; cervical canal and intrauterine abnormalities were found in 10 and 32 patients, respectively. Ten patients were treated during hysteroscopic evaluation procedure, and four patients subsequently underwent operative hysteroscopy under general anesthesia. We suggest that diagnostic hysteroscopy should be a routine procedure before in vitro fertilization and embryo transfer therapy.     

不同黄体支持方法对体外受精-胚胎移植结果的影响

目的:探讨三种黄体支持方法对体外受精-胚胎移植(IVF-ET)结果的影响。方法:回顾性分析195个IVF-ET周期的结果,根据注射hCG当天的血E2水平、B超示直径≥14 mm卵泡数目及所用的黄体支持方法分组。A组:112例,E2<2 000 pg/mL,直径≥14 mm的卵泡数<10个,hCG进行黄体支持;对E2≥2 000 pg/mL,卵泡数目≥10个者,随机分为两组,B组,46例,单用黄体酮进行黄体支持;C组,37例,黄体酮加雌激素进行黄体支持。结果: 三组间妊娠率、种植率、流产率、OHSS发生率差异均无显著性,P>0.05。结论:hCG用于IVF黄体支持并不优于黄体酮,但在一定程度上可避免某些患者由于注射黄体酮产生的痛苦。黄体酮+雌激素进行黄体支持应该是黄体支持较合理的方案,还需进一步研究。     

Office hysteroscopy in an in vitro fertilization program

Objective. In the present paper we evaluate the incidence of intrauterine pathologies in a population undergoing in vitro fertilization (IVF) treatment. Moreover, we compare the IVF outcome between patients with normal and abnormal uterine findings to determine if office hysteroscopy (OH) is of any clinical significance.

Methods. The hysteroscopic findings in 866 consecutive patients were analyzed. The study group included 555 patients at the first IVF attempt and 311 patients with two or more failed IVF cycles.

Results. All hysteroscopic parameters were considered normal in 514 cases (59.4%); in 352 cases (40.6%) various pathological conditions were found. Patients were divided into two groups according to the hysteroscopic findings. The implantation and pregnancy rates were similar between the groups. Comparing the clinical outcomes in patients with repeated IVF failure who had hysteroscopy with no pathology and with pathology, we did not find any statistical differences.

Conclusions. This study suggests that hysteroscopy as a routine infertility examination should be performed in all patients, owing to the elevated incidence of hysteroscopic pathological findings (59.4%); hysteroscopy also seems to be the best way to repair the uterine cavity when pathological conditions are present. However, performing OH before IVF–embryo transfer is of no significant value in improving pregnancy outcomes.     

In vitro fertilization in tuberculous infertility

Twenty women, suffering from infertility due to histologically proved genital tuberculosis, were managed by in vitro fertilization (IVF) in 49 attempts. The main histopathological lesions were tuberculous salpingitis in 12 women, tuberculous endometritis in 5, and pelvic peritoneal tuberculosis in 3. A preliminary evaluation including, particularly, a laparoscopy and a hysteroscopy was performed. Five deliveries and one ongoing pregnancy were obtained. The result suggest that IVF now-adays represents the only treatment for tuberculous infertility.     

IVF-ET后妊娠并发粟粒性肺结核3例病案报道并文献复习

目的:探讨IVF-ET后妊娠并发粟粒性肺结核的发生规律、疾病特点和检查治疗的方法。方法:回顾分析3例IVF-ET后妊娠并发粟粒性肺结核病例的疾病特点和诊治方法。结果:本文3例加文献7例共10例IVF-ET并发粟粒性肺结核患者,均行IVF-ET受孕,主要临床表现为发热,可伴有发冷、寒战等症状,可查的结核菌素实验均为阴性。10例患者中通过胸片诊断4例,通过胸部CT诊断4例,均为粟粒性小结节。从发热至影像学确诊的时间间隔,最短11 d,最长达9周。10例患者中9例患者在经系统抗结核治疗后病情好转,预后良好,仅本研究的1例患者出现昏迷,目前遗留智力障碍。10例中主动终止妊娠2例,出现流产情况7例,胎儿存活3例。结论:IVF-ET并发粟粒性肺结核临床表现不典型,给疾病的诊断带来困难。IVF-ET妊娠后,对持续较长时间的不明原因发热、抗生素治疗无效的孕妇,应尽早进行结核病相关检查。     

生长激素在IVF-ET周期子宫内膜发育不良患者中的应用

目的:探讨生长激素(growth hormone,GH)在体外受精-胚胎移植(in vitro fertilization-em-bryo transfer,IVF-ET)治疗中对子宫内膜发育不良者子宫内膜及临床结局的影响。方法:IVF-ET患者共67例,均由于子宫内膜发育不良而致IVF-ET种植失败,再次行IVF-ET治疗时随机分为研究组(加用GH治疗,32例)和对照组(未使用GH治疗,35例),统计分析患者的临床结局。结果:患者Gn用量、平均获卵数、受精率、优质胚胎率组间无统计学差异(P>0.05);研究组子宫内膜厚度、形态及子宫内膜和内膜下血流均较对照组有明显改善(P<0.01);研究组的胚胎种植率(31.4%)及临床妊娠率(39.5%)明显高于对照组(15.7%和19.8%)(P<0.01),早期流产率明显减低(14.6%vs 21.4%)(P<0.01)。结论:对内膜发育不良的患者进行IVF-ET治疗时加用GH可能是通过改善子宫内膜对胚胎的容受性,从而提高胚胎种植率及临床妊娠率,降低早期流产率。     

The value of hysteroscopy in elderly women prior to in vitro fertilization-embryo transfer (IVF-ET): A comparative study

Two hundred eighty-four hysteroscopies were performed in 312 (91%) candidates for in vitro fertilization and embryo transfer (IVF-ET) who were divided into two groups. Group I consisted of elderly women over 40 years, and group II of women below this age. Although visualization revealed uterine abnormalities in 29.9% of all patients, abnormal findings were significantly increased in the former group in comparison to the latter (P<0.001). This difference was attributed mainly to uterine rather than cervical pathology. Furthermore, in elderly women agerelated uterine pathology such as submucous myomata, endometrial hyperplasia, and polyps were more prominent, while in younger patients other uterine lesions such as adhesions and tubal ostia occlusion were more common. Moreover, treatment prior to IVF-ET resulted in 7 clinical pregnancies (8.9%) in group I and in 41 clinical pregnancies (19.9%) in group II, all of which failed in one to three cycles previously. It seems that hysteroscopic evaluation may reduce the IVF-ET failure rate due to intrauterine abnormalities in elderly as well as young patients, thus it becomes an absolute prerequisite for all patients scheduled for an IVF program.     

Local injury to the endometrium doubles the incidence of successful pregnancies in patients undergoing in vitro fertilization

OBJECTIVE: Exploration of the possibility that local injury of the endometrium increases the incidence of implantation. DESIGN: Prospective study. SETTING: Clinical IVF unit. PATIENT(S): A group of 134 patients, defined as good responders to hormonal stimulation, who failed to conceive during one or more cycles of IVF and embryo transfer (ET). INTERVENTION(S): The IVF treatment and ET were preceded by repeated endometrial biopsies, in a randomly selected 45 of a total of 134 patients. MAIN OUTCOME MEASURES: Outcome of IVF-ET treatments. RESULT(S): Transfer of a similar number of embryos (3.4 +/- 1.0 and 3.1 +/- 0.9 in the experimental and control patients, respectively) resulted in rates of implantation (27.7% vs. 14.2%, P =.00011), clinical pregnancy (66.7% vs. 30.3%, P =.00009), and live births per ET (48.9% vs. 22.5%, P =.016) that were more than twofold higher in the experimental group as compared to controls. CONCLUSION(S): These results suggest that IVF treatment that is preceded by endometrial biopsy doubles the chance for a take-home baby.     

益气养血补肾活血中药在体外受精-胚胎移植患者中的应用

目的:观察益气养血补肾活血中药对体外受精-胚胎移植(IVF-ET)患者应用的功效。方法:对32例拟行IVF-ET的不孕症患者(包括反复IVF移植失败者8例、IVF妊娠后先兆流产者7例、胚胎质量差者7例、卵巢低反应者5例、卵巢功能减退者4例和不明原因不孕者1例)予以益气养血、益肾活血中药治疗,通过B超观察窦卵泡计数(AFC)、胚胎移植时子宫内膜厚度及血基础FSH、LH、E2、P水平等指标,观察用药前、后疗效。结果:予以益气养血补肾活血中药治疗后,有4例(4/8)IVF移植反复失败者成功妊娠;有5例(5/7)IVF妊娠后先兆流产史者继续妊娠;有5例(5/7)胚胎质量差者胚胎质量提高;有3例(3/5)对控制性超促排卵(COH)反应性提高;卵巢功能恢复正常范围者3例(3/4);不明原因不孕者妊娠1例。结论:益气养血补肾活血中药在辅助生殖治疗中发挥了积极作用。