体外受精胚胎移植失败患者的宫腔镜表现及治疗价值

目的评价体外受精胚胎移植(in vitro fertilization embryo transferred,IVF-ET)失败患者的宫腔因素及宫腔镜的诊治意义.方法对52例体外受精(IVF)失败者进行宫腔镜检查及治疗后,行IVF-ET(36例),并与40例IVF失败而未做宫腔镜检查者比较再次IVF-ET的临床妊娠率.结果宫腔镜检查发现宫腔异常率为36.5%(19/52),其中子宫内膜息肉68.4%(13/19),子宫内膜息肉样增生10.5%(2/19),子宫内膜炎症10.5%(2/19),子宫内膜复合增生5.3%(1/19),宫腔轻度粘连5.3%(1/19).52例中36例进行再次IVF-ET,根据宫腔镜结果分为宫腔正常组23例及异常组13例.再次IVF-ET的临床妊娠率宫腔正常组和异常组均高于对照组(分别为30.4%、38.5%、20.0%),但无显著性差异.结论IVF-ET失败患者宫腔镜检查阳性率高,宫腔镜是寻找IVF-ET失败原因很有价值的检查手段,建议对反复IVF-ET失败者常规应用.

Uterine cavity findings and effect of hysteroscopic treatment in patients with IVF failure

Objective To assess the uterine status of patients undergoing IVF-ET who failed to conceive despite transfering of good-quality embryos and the value of hysteroscopy. Methods Diagnosis and treatment by hysteroscopy were performed in fifty-two patients whose IVF-ET cycles failed despite transfer of good-quality embryos before the subsequent IVF attempt. The control group included fourty patients without hysteroscopy and whose IVF-ET cycles failed before the subsequent IVF attempt. Results Thirty-three(63.5%)patients had normal endometrial findings; nineteen (36.5%) patients had abnormal endometrial findings and underwent treatment for the lesions, included 13 endometrial polyps, 2 poly-like hyperplasia, 2 endometritis, 1 endometrial complex hyperplasia, 1 mild intrauterine adhesions. Thirty-six patients underwent subsequent IVF-ET cycle, according to the result of hysteroscopy, there were normal hysteroscopic finding group and abnormal hysteroscopic finding group. The clinical pregnancy rates in hysteroscopic normal group, abnormal group and control group were 30.4%?38.5%?20.0% respectively. There was no significant difference in the clinical pregnancy rate of patients among the three groups. Conclusions The incidence of pathologic findings on hysteroscopy is high in patients who fails of IVF-ET. Evaluation of endometrial integrity by hysteroscopy is highly valuable and should be applied to all cases.