宫腔镜在体外受精-胚胎移植失败病例中的应用价值

目的]探讨官腔镜在体外受精-胚胎移植(IVF-ET)失败病例诊断中的应用价值.方法]收集从1996到2004年在中山大学附属第一和第二医院生殖中心行体外受精-胚胎移植失败患者107例,在我院进行了宫腔镜检查,其中83例进行了内膜活检,总结分析该资料.结果]宫腔镜发现正常官腔74例(69.16%),异常33例(30.84%),其中包括宫腔粘连6例、内膜薄6例、官腔息肉6例、内膜肥厚5例、黏膜下子宫肌瘤4例、宫颈管狭窄3例、内膜炎2例、子宫纵隔1例.83例子宫内膜病理活检则发现正常内膜54例(65.06%),其中增生期18例、分泌期36例;内膜异常29例(34.94%),其中黄体功能不全(LDP)12例、轻度增生过长7例(其中有一例同时伴有宫腔息肉),内膜炎症5例、宫腔息肉3例、子宫内膜结核2例.结论]对体外受精-胚胎移植失败病例,进行宫腔镜检查有助于明确病因.

Role of Hysteroscopy in the Failure Cases After in vitro Fertilization-Embryo Transfer

Objectives] To evaluate the role of hysteroscopy in the failure cases after in vitro fertilizationembryo transfer(IVF-ET). Methods] One hundred and seven patients who failed to conceive after in vitro fertilization-embryo transfer in two centers of assisted reproductive medicine were collected. All the patients underwent the hysteroscopic examination and 83 of them also had endometrial biopsy. Results] During hysteroscopic examination, there were 74 patients (69.16%) with normal uterine cavity and 33 patients (30.84%) with abnormal uterine cavity. The intrauterine abnormalities include adhesion, thin endometrium, endometrial polyps, thick endometrium, submucosal myomas, cervical canal stenosis, endometritis, and uterine septum. During endometrial histological examination in 83 patients, there were 54 patients (65.06%) with normal endometrium, 18 of them were in proliferative phase and 36 were in secretory phase. There were 29 patients (34.94%) with abnormal endometrium, among them 12 with luteal phase defeat (LPD), 7 with hyperplasia of endometrium, 5 with endometritis, 3 with endometrial polyps, and 2 with endometrial tuberculosis. Conclusion] The incidence of pathologic findings by hysteroscopy is high in patients with repeated IVF-ET failures. Evaluation of endometrial integrity by hysteroscopy is highly valuable and should be applied to all such cases.