子宫内膜异位症患者行体外受精-胚胎移植结局分析  

Analysis of outcome of IVF-ET in patients with endometriosis

作　　者：李脉[1] 周黎明[1] 孙亦婷[1] 赵雅云[1] 夏爱丽[1] 屈煜[1] 

机构地区：[1]浙江宁波市妇女儿童医院生殖中心,宁波315000

出　　处：《生殖医学杂志》2015年第5期386-391,共6页Journal of Reproductive Medicine

摘　　要：目的分析子宫内膜异位症（EMs）不同严重程度和不同降调节方案对体外受精-胚胎移植（IVF-ET）的临床结局的影响。方法回顾性分析本中心2010年1月至2013年12月行IVF-ET的患者。在选定长方案为分析对象中,1 822例输卵管因素患者,239例EMs,包括219例Ⅰ~Ⅱ期,20例Ⅲ~Ⅳ期,分析各组间受精率、卵裂率、胚胎着床率、临床妊娠率、流产率及异位妊娠率的差异。另外,进一步分析Ⅲ~Ⅳ期组中不同降调节方案的IVF-ET结局,其中包括38个长方案周期,119个超长方案周期,29个短方案及拮抗剂方案。结果Ⅲ~Ⅳ期EMs组的促性腺激素（Gn）总量比Ⅰ~Ⅱ期及输卵管组均高,而获卵数、受精率、优质胚胎数明显低于其他组（P〈0.05）;但三组的着床率、临床妊娠率、流产率及异位孕率比较差异均无统计学意义（P〉0.05）。在Ⅲ~Ⅳ期EMs组中,行短方案及拮抗剂方案组的Gn总量显著低于长方案及超长方案组,且获卵数显著低于其他组（P〈0.05）;三组的优质胚胎率、着床率、临床妊娠率、流产率、异位妊娠率均无统计学差异（P〉0.05）,但超长方案的着床率、临床妊娠率较其他两组有升高趋势。结论不同严重程度的EMs患者行IVF-ET可获得和输卵管因素患者相同的成功率;超长方案对于Ⅲ~Ⅳ期EMs的胚胎质量无明显改善,但有提高胚胎着床率及临床妊娠率的趋势。Objective：To analyze the clinical outcome of IVF-ET with different down-regulation protocols in infertile patients with the different severity of endometriosis（EMs）.Methods：The data of infertile patients undergone IVF-ET in our center from January 2010 to December 2013 were retrospectively analyzed.There were 1 822 patients with tubal factors and 239 patients with EMs including 219 with stage I-Ⅱand 20 with stageⅢ-Ⅳin long down-regulation protocol.The fertilization rate,cleavage rate,implantation rate,clinical pregnancy rate,abortion rate,ectopic pregnancy rate were compared among the three groups.In addition,the outcome of IVF with the different down-regulation protocol was compared in the patient with stageⅢ-Ⅳof EMs.There were 38 cycles with long protocol,119 cycles with prolonged protocol and 29 cycles with short and antagonist protocol.Results：The dose of gonadotropin（Gn）used was significantly higher,but the number of oocytes retrieved,the fertilization rate and the number of high quality embryo were significantly lower in the patients with stage Ⅲ-Ⅳ of EMs than those in the patients with stageⅠ-Ⅱ or the patients with tubal factors（all P〈0.05）.The implantation rate,clinical pregnancy rate,abortion rate and ectopic pregnancy rate were not significantly different among the three groups（P〉0.05）.In addition,the dose of Gn usedand the number of oocytes retrieved in short and antagonist protocols were significantly less than those in long and prolonged protocols（P〈0.05）.The high quality embryo rate,implantation rate,clinical pregnancy rate,abortion rate and ectopic pregnancy rate were not significantly different among the three groups（P〉0.05）.There was improving tendency in implantation rate and clinical pregnancy rate in prolonged protocol.Conclusions：Infertile women with various stages of EMs can obtain similar clinical outcome as the patients with tubal factor in long protocol.The prolonged protocol can not improve quality of embryos,but may improve the i

关 键 词：子宫内膜异位症 体外受精-胚胎移植 降调节 输卵管因素 临床妊娠率 

分 类 号：R[医药卫生]