剖宫产史对体外受精周期结局的影响

目的探讨在体外受精胚胎移植周期中,既往剖宫产史对于体外受精(IVF)助孕周期过程及助孕结局的影响。方法回顾性分析2015年1月1日至2018年3月30日期间在西北妇女儿童医院生殖中心进行IVF助孕治疗的患者数据,根据既往有无孕28周以上剖宫产史或阴道分娩史将1 070例患者分为剖宫产史组和阴道分娩史组。比较两组间IVF新鲜移植周期中因宫腔积液取消新鲜移植率及两组的临床妊娠结局。结果剖宫产史组与阴道分娩史组无论移植1枚还是2枚胚胎,新鲜胚胎移植周期临床妊娠率(移植1枚:52.3%vs. 43.8%;移植2枚:50.0%vs. 52.0%)、早期流产率(移植1枚:9.0%vs. 9.9%;移植2枚:21.6%vs. 12.9%)及继续妊娠率(移植1枚:47.7%vs. 39.5%;移植2枚:39.2%vs. 44.0%)比较差异均无统计学意义(χ~2值分别为1.202、0.171、0.074、1.137、1.107、1.203,均P>0.05);剖宫产史组中因宫腔积液取消新鲜移植的发生率明显高于阴道分娩史组,差异有统计学意义(3.7%vs. 0.39%,χ~2=2.339,P <0.05)。结论剖宫产史并不影响IVF新鲜移植周期临床妊娠率、早期流产率及继续妊娠率,但剖宫产史增加患者在IVF新鲜周期中宫腔积液的可能,并导致因宫腔积液取消新鲜胚胎移植的发生率升高。

Effect of cesarean section history on outcomes of in Vitro fertilization cycle

Objective To evaluate impact of past cesarean section history on proconceptive cycle processes and outcomes of in vitro fertilization(IVF). Methods The clinical data of 1070 women with a delivery history at ≥ 28 weeks of gestational age who underwent IVF cycles in The Assisted Reproduction Technology Center of The Northwest Women and Children’s Hospital from January 1, 2015 to March 30, 2018 were retrospectively analyzed. According to their prior delivery history at ≥ 28 weeks of gestational age, the women were divided into two groups-cesarean delivery(CD) history group and vaginal delivery(VD) history group. The cancellation rate of fresh embryo transplantation(ET) due to endometrial cavity fluid(ECF) and clinical pregnancy outcomes such as clinical pregnancy rate, early spontaneous abortion rate and ongoing pregnancy rate of the women between the two groups were compared. Results There were no statistically significant differences between CD history group and VD history group in clinical pregnancy rate(for 1 piece of fresh emebryo transplanted: 52.3% vs. 43.8%, P = 0.136;for 2 pieces of fresh emebryos transplanted:50.0% vs. 52.0%, P = 0.752), early spontaneous abortion rate(for 1 piece of fresh embryo transplanted: 9.0% vs. 9.9%, P = 0.849;for 2 pieces of fresh embryos transplanted: 21.6% vs. 12.9%, P = 0.1640) and ongoing pregnancy rate(for 1 piece of fresh embryo transplanted: 47.7% vs. 39.5%, P = 0.136;for 2 pieces of fresh embryos transplanted: 39.2% vs. 44.0%, P = 0.150). The cancellation rate of fresh embryo transplantation(ET) due to endometrial cavity fluid(ECF) was higher in the prior CD history group(3.7% vs. 0.39%, P<0.001). Conclusion Prior cesarean delivery does not affect clinical pregnancy rate, early spontaneous abortion rate and ongoing pregnancy rate in fresh ET IVF cycle. But the prior CD history results in a higher cancellation rate of fresh ET due to ECF.