剖宫产术后瘢痕子宫对辅助生殖助孕策略的影响  

Treatment strategy of the scar uterus patients in assisted reproduction

作　　者：吴晓丽[1] 禹虹[1] 罗曼[1] 阳翎[1] 唐慧珍[1] 柳朝华[1] 陈辉莲[1] 黎南南 Wu Xiaoli;Yu Hong;Luo Man;Yang Ling;Tang Huizhen;Liu Zhaohua;Chen Huilian;Li Nannan(Reproductive Medicine Center,Hunan Provincical Maternal and Child Care Hospital,Changsha 410008,China)

机构地区：[1]湖南省妇幼保健院生殖中心,长沙410008

出　　处：《中国医师杂志》2020年第9期1332-1336,1341,共6页Journal of Chinese Physician

基　　金：湖南省卫健委基金(20190795);湖南省自然科学基金(2019JJ80038)。

摘　　要：目的探讨剖宫产术后瘢痕子宫对辅助生殖助孕策略的影响。方法回顾性分析2017年1月1日至12月31日本院行体外受精-胚胎移植(IVF-ET)助孕鲜胚移植的瘢痕子宫组109例和阴道分娩史组63例患者的病例资料,比较两组患者的超促排效果和妊娠结局。结果⑴年龄<35岁的瘢痕子宫组和阴道分娩史组患者超促排卵时促性腺激素(Gn)总量、Gn总天数差异无统计学意义(P>0.05),但瘢痕子宫组患者获卵数、成熟卵子数、2PN数、优良胚胎数与阴道分娩史组患者比较差异均有统计学意义(P<0.05)。当年龄≥35岁时,两组患者间Gn总量、Gn总天数、获卵数、成熟卵子数、2PN数、优良胚胎数均无统计学意义(P>0.05)。⑵年龄<35岁患者无论是单胚胎移植还是双胚胎移植,两组患者的临床妊娠率、胚胎着床率差异均无统计学意义(P>0.05)。但是移植两枚胚胎时,瘢痕子宫组患者临床妊娠率、胚胎着床率均稍低于阴道分娩史组患者(57.57% vs 71.05%,39.39% vs 47.37%),差异无统计学意义(P>0.05)。年龄≥35岁的患者中,单胚胎移植和双胚胎移植的临床妊娠率、胚胎着床率差异均无统计学意义(P>0.05)。⑶年龄<35岁的患者和年龄≥35岁的患者中,瘢痕子宫组和阴道分娩史组患者的生化妊娠率、早期流产率、早产率、新生儿体重差异均无统计学意义(P>0.05)。结论剖宫产手术后IVF助孕可能会影响患者获卵数和成熟卵数,既往剖宫产手术史的患者,再生育前建议尽早评估卵巢功能,必要时积极助孕。单胚胎移植并不降低剖宫产瘢痕子宫患者IVF-ET助孕结局,建议剖宫产瘢痕子宫患者行单胚胎移植,降低双胎妊娠后孕产期风险。Objective To investigate the effect of scar uterus on assisted reproduction treatment strategy.Methods From January 1,2017 to December 31,2017,109 cases of scar uterus group and 63 cases of vaginal delivery history group who underwent in vitro fertilization-embryo transfer(IVF-ET)assisted pregnancy fresh embryo transfer in our hospital were retrospectively analyzed.Results(1)There was no significant difference in the total amount of gonadotropin(Gn)and the total days of GN in patients<35 between scar uterus group and the vaginal delivery history group(P>0.05),but there were significant differences in the number of oocytes,mature oocytes,two pronucleus(2PN)and excellent embryos between the scar uterus group and the vaginal delivery history group(P<0.05).When the age was≥35 years old,there was no significant difference in the total number of GN,the total days of GN,the number of oocytes obtained,the number of mature oocytes,the number of 2PN and the number of excellent embryos between the two groups(P>0.05).(2)There were no statistically significant differences in clinical.pregnancy rate and embryo implantation rate between the two groups of patients<35 years old,no matter single embryo transplantation or double embryos transplantation.When transplant two embryos,the clinical pregnancy rate and embryo implantation rate in the scar uterus group were slighdy lower than those in the vaginal delivery history group(57.57%vs 71.05%and 39.39%vs 47.37%,respectively),but with no significant difference(P>0.05).There were no statistically significant differences in the clinical pregnancy rate and embryo implantation rate between single embryo transplantation and double embryo transplantation in patients>35 years old(P>0.05).(3)There were no statistically differences in biochemical pregnancy rate,early a-bortion rate,preterm birth rate and average newborn weight between the scar uterus group and the vaginal delivery history group(P>0.05).Conclusions Cesarean section may affect the ovarian function.For patients with previous

关 键 词：生殖技术 辅助 瘢痕子宫 阴道分娩 胚胎移植 

分 类 号：R714.8[医药卫生—妇产科学]