枸橼酸西地那非对宫腔粘连术后冻融胚胎移植妊娠结局的影响

目的：观察枸橼酸西地那非（万艾可）对宫腔粘连（intrauterine adhesion，IUA）分离术后冻融胚胎移植（frozen embryo transfer，FET）患者妊娠结局的影响。方法：选择2017年1-12月在南京医科大学附属妇产医院行FET的不孕症患者，在进入FET周期前宫腔镜检查确诊IUA，行宫腔镜下IUA分离术，术后复查宫腔镜显示宫腔形态正常行FET，共310例。根据患者是否添加枸橼酸西地那非将患者分为2组，其中A组（对照组）实施激素替代周期FET，共190例；B组（治疗组）为激素替代周期并在患者月经干净后每日阴道给予枸橼酸西地那非50 mg，应用至移植前，共120例。首先比较2组患者的妊娠结局，其次将A组及B组患者进一步分为轻度IUA组和中重度IUA组，比较2组之间的差异。结果：B组临床妊娠率［50.83%（61/120）］高于A组［34.74%（66/190）］，差异有统计学意义（P＜0.05）；B组胚胎种植率［31.17%（72/231）］略高于A组［21.82%（79/362）］，但差异无统计学意义（P＞0.05）。与A组相比，B组轻度IUA患者的临床妊娠率与胚胎种植率差异无统计学意义（P＞0.05）；B组中重度IUA患者的临床妊娠率［44.78%（30/67）］及胚胎种植率［28.46%（37/130）］均高于A组，差异有统计学意义（P＜0.05）。2组间流产率和异位妊娠率比较差异均无统计学意义（P＞0.05）。结论：应用枸橼酸西地那非可提高IUA术后患者子宫内膜容受性，尤其对中重度IUA术后患者可显著提高其FET妊娠率。

Effects of Sildenafil Citrate on Pregnancy Outcomes in Frozen Embryo Transfer Patients after Resection of Intrauterine Adhesion

Objective：To investigate the effects of sildenafil citrate on the pregnancy outcomes of frozen embryo transfer (FET) in patients after the resection of intrauterine adhesion (IUA). Methods: A total of 310 infertile patients receiving FET who were diagnosed as IUA between January and December 2017, and resected IUA under hysteroscopy before their FET treatment, were included. The 190 cases in the control group were given the FET cycle with hormonal replacement, while the 120 patients in the test group were given the above FET cycle combined with sildenafil citrate. After the menstruation was clean, 50 mg of sildenafil citrate was administrated vaginally every day until the transplantation. Firstly, the gestational outcomes were compared between the two groups. Each group was subdivided into two subgroups: a gentle IUA subgroup and a medium-severe IUA subgroup. The gestational outcomes were then compared again. Results: The clinical pregnancy rate in the test group was significantly higher than that in the control group[50.83% (61/120) vs. 34.74% (66/190), P＜0.05]. However, there was no significant difference in the embryo implantation rate between the two groups [31.17% (72/231) vs. 21.82% (79/362), both P＞0.05]. There was no significant difference in the clinical pregnancy rate or embryo implantation rate between the two gentle IUA subgroups. However, The clinical pregnancy rate [44.78% (30/67)] and the embryo implantation rate [28.46% (37/130)] in the medium-severe IUA subgroup of the test group were significantly higher than those in the medium-severe IUA subgroup of the control group (both P＜0.05). No significant differences were found in the miscarriage rate and the ectopic pregnancy rate between the two groups (P＞0.05). Conclusions: Sildenafil citrate can improve the endometrial receptivity after IUA, and can significantly increase the pregnancy rate of FET in those medium-severe IUA patients.