IVF失败患者月经期子宫内膜雌、孕激素受体变化对复融周期妊娠率的影响

目的:探讨体外受精-胚胎移植/卵胞浆内单精子注射(IVF/ICSI)周期失败患者复融周期月经期子宫内膜雌、孕激素受体变化对妊娠率的影响。方法:选取2009年1月～2010年1月IVF/ICSI周期失败患者,复融周期月经来潮24 h内行内膜搔刮术,将刮出物中少量子宫内膜组织送病理检查。按子宫内膜病理分型,分为分泌正常、分泌反应欠佳、增生反应型子宫内膜,比较各组子宫内膜雌、孕激素受体变化及复融周期胚胎种植率、妊娠率及流产率。结果:共获病理报告317例,分泌正常子宫内膜共96例,分泌反应欠佳子宫内膜共143例,增生反应型子宫内膜共78例。增生反应组宫外孕发生率(6.41%)高于分泌反应正常组(0.00%)和分泌反应欠佳组(1.39%),差异有统计学意义(P<0.05)。分泌反应正常组的胚胎着床率(45.79%)和生化妊娠率(62.5%)均高于分泌反应欠佳组(38.08%,50.35%)和增生反应组(34.84%,47.43%),但差异无统计学意义(P>0.05)。分泌反应欠佳组流产率(14.69%)高于分泌反应正常组(7.29%)和增生反应组(8.97%),但差异无统计学意义(P>0.05)。结论:复融周期胚胎移植可以选择分泌良好的周期进行,以提高移植的成功率。

Effects of changes of estrogen receptor and progestogen receptor levels in endometrium during menstrual period on pregnancy rate of post-thawing cycle in patients failing in IVF

Objective:To investigate the influence of changes of estrogen receptor and progesterone receptor in menstrual endometrium on pregnancy rate of post-thawing cycle of patients failing in IVF/ICSI cycles.Methods:The patients failing in IVF/ICSI cycles from January 2009 to January 2010 were retrieved.These patients underwent endometrial curettage within 24 hours after menstrual onset and pathological examination of endometrial tissue was conducted.There were 3 types of endometrium: type 1(endometrium with normal secretion function),type 2(endometrium with poor secretion function),type 3(endometrium with hyperplasia).The changes of estrogen receptor and progesterone receptor,embryo implantation rate,pregnancy rat,e and abortion rate in the three groups were compared.Results:In the total 347 cycles,there were 96 cycles with normal endometrial secretion function,143 cycles with poor endometrial secretion function and 78 cycles with hyperplasia endometrium.The incidence rate ofexfetation in hyperplasia endometrium group(6.41%) was higher than those in the other two groups,which was 0% and 1.39%,respectively,and there was statistically significant difference(P<0.05).Both embryo implantation rate and biochemical pregnancy rate in normal endometrial secretion function group(45.79% and 62.5%) were higher than those in poor endometrial secretion function group(38.08% and 50.35%) and endometrium with hyperplasia group(34.84% and 47.43%),but there was no statistically significant difference(P>0.05).The abortion rate in poor endometrial secretion function group(14.69%) was higher than those in normal endometrial secretion function group(7.29%) and endometrium with hyperplasia group(8.97%),but there was no significant difference(P>0.05).Conclusion:In order to improve pregnancy rate,thawing cycle should be carried out during menstruation with satisfied secretion function.