宫腔镜在辅助生殖技术前的应用价值

随着辅助生殖技术的开展,移植前宫腔镜检查评估宫腔越来越受到重视,尤其对于体外受精-胚胎移植(IVF-ET)反复着床失败的患者,宫腔镜检查和治疗有助于改善IVF-ET的妊娠结局。在不孕女性中,子宫内异常病变发生率为10%~15%,这些异常包括子宫内膜息肉、子宫黏膜下肌瘤、子宫纵隔、宫腔粘连、子宫内膜炎。经阴道二维超声(TVS)、子宫输卵管造影(HSG)、宫腔注水超声(SIS)可用于评估宫腔情况,而宫腔镜检查仍是诊断宫内病变的金标准,但对于子宫内膜炎组织病理学才是诊断的金标准。宫腔镜手术是治疗宫内病变的有效方法,宫腔镜下子宫内膜息肉电切术、子宫肌瘤电切术、子宫隔膜切除术及宫腔粘连分离术,术后妊娠率均有显著提高,宫腔镜手术后进行辅助生殖的时机因手术方式不同而不同,通常术后1~3个月不等。值得肯定的是宫腔镜检查在不孕症诊治中发挥了重要作用,但是否对于所有拟进行IVF-ET的患者常规进行宫腔镜检查尚有争议。

Hysteroscopy Prior to the Assisted Reproductive Technology:A Review

With the extensive use of assisted reproductive technology (ART),it is more and more important to evaluate routinely the uterine cavity by hysteroscopy before the in vitro fertilization-embryo transfer (IVF-ET) cycle,particularly in those patients with repeated implantation failure (RIF).It has been confirmed that hysteroscopy in examination and treatment can improve the clinical outcomes of IVF-ET.The incidence of intrauterine abnormity is about 10％ to 15％,such as polyps,submucous myoma,septum,adhesions and chronic endometritis.Vaginal sonography,hysterosalpingography,and saline infusion sonography can be used to evaluate the uterine cavity,while hysteroscopy examination is the golden standard for the diagnosis of intrauterine pathologies.However,the histological examination is the last standard for the diagnosis of endometritis.Hysteroscopy is also an effective tool for the treatment of intrauterine pathologies.The pregnant rate can be significantly increased in those women underwent hysteroscopic surgery,such as transcervical resection of the endometrial polyps (TCRP),transcervical resection of the myoma (TCRM),transcervical resection of the septum (TCRS),and transcervical resection of the intrauterine adhesions (TCRA).The duration after hysteroscopic surgery,for the IVF-ET treatment,depends on the kind of hysteroscopic surgery,ranged from 1 to 3 months.It is true that hysteroscopy plays an important role in the diagnosis and treatment of infertility.However,it is still under debate whether all of infertile women have a routine hysteroscopy before their IVF-ET treatment.