体外受精-胚胎移植失败后宫腔镜检查91例分析

目的探讨宫腔镜在助孕治疗失败后要求再次进行体外受精-胚胎移植（IVF-ET）的患者中的应用价值。方法回顾性分析行IVF-ET失败后要求再次行IVF-ET患者91例，根据第二次IVF-ET前接受宫腔镜检查情况分为宫腔形态正常组（A组）与宫腔形态异常组（B组），分析宫腔镜检查情况，并比较两组在重复IVF-ET周期中优质胚胎率、着床率、临床妊娠率。结果91例中宫腔镜检查宫腔形态正常49例（54％），发现宫腔内微小病变42例（46％），包括子宫内膜息肉、子宫内膜炎、宫腔轻度粘连、子宫黏膜下肌瘤、子宫内膜增殖和子宫内膜发育不良，宫腔形态异常组经宫腔镜矫治后着床率、临床妊娠率明显提高。结论 宫腔镜可以发现存在于宫腔内的微小病变;IVF-ET失败患者应放宽宫腔镜检查指征,以提高重复周期的临床妊娠率和着床率。

Application of diagnostic hysteroscopy in 91 patients with in vitro fertilization-embryo transfer failure

Objective： To analyze the hysteroscopic findings in the patients with a previous in vitro fertilization- embryo transfer （IVF-ET） failure and evaluate the application of diagnostic hysteroscopy before the repeated cycles.
Methods： Ninety-one patients who had experienced the failed IVF-ET cycles were subject to the diagnostic hysteroscopy before the new cycles. The hysteroscopic findings were recorded, and abnormalities corrected. One year later, IVF-ET cycles were repeated.
Results： In 91 patients, 49 （54%） had normal hysteroscopic findings （Group A） and 42 （46%） had abnormal hysteroscopy findings （Group B） such as endometrial polyps, endometritis, intrauterine adhe- sion. In the new IVF-ET cycles, both implantation rate and pregnancy rate in Group B were significantly higher than those in Group A, which showed that the correction of abnormalities by hysteroscopy greatly improved the implantation rate and pregnancy rate.
Conclusions： Diagnostic hysteroscopy can help to find and correct the minor intrauterine abnormali- ties. Patients with normal hysterosalpingography findings who failed to conceive in IVF-ET cycles should also be reevaluated using hysteroscopy prior to further commencing cycles in order to improve the clinical pregnancy rate.