垂体降调节前后行宫腔镜下子宫内膜息肉切除术对IVF-ET结局影响比较  

Comparison of IVF-ET outcomes in patients undergoing hysteroscopic endometrial polypectomy before and after pituitary down-regulation

作　　者：刘唱 陈慧慧[1] 陈宇峰 付养华 徐肖文[1] 赵军招[1] LIU Chang;CHEN Huihui;CHEN Yufeng;FU Yanghua;XU Xiaowen;ZHAO Junzhao(Reproductive Medical Center,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027,China)

机构地区：[1]温州医科大学附属第二医院生殖中心,325027 [2]温州医科大学附属第一医院生殖中心

出　　处：《浙江医学》2020年第23期2506-2510,共5页Zhejiang Medical Journal

摘　　要：目的比较垂体降调节前后行宫腔镜下子宫内膜息肉切除术(TCRP)对首次行体外受精-胚胎移植(IVF-ET)患者妊娠结局的影响。方法选取2016年6月至2017年12月在温州医科大学附属第二医院生殖中心首次采用早卵泡期超长方案助孕,且在新鲜胚胎移植前曾行TCRP的不孕症患者228例。其中在垂体降调节后行TCRP患者117例为Ⅰ组,在垂体降调节前行TCRP患者111例为Ⅱ组。比较两组患者的妊娠结局。结果Ⅰ组患者行TCRP术后大约(44.26±5.14)d行胚胎移植,Ⅱ组患者行TCRP术后(80.03±6.87)d行胚胎移植。两组患者使用促性腺激素(Gn)天数和剂量、获卵数、移植日子宫内膜厚度、胚胎移植数、胚胎移植类型比较差异均无统计学意义(均P>0.05)。两组患者胚胎着床率(40.4%比37.2%)、临床妊娠率(62.9%比58.1%)、活产率(55.7%比49.5%)、异位妊娠率(1.6%比1.9%)、生化妊娠率(8.2%比9.7%)、自然流产率(9.8%比13.0%)、双胎妊娠率(19.7%比27.8%)、IVF-ET周期取消率(17.1%比17.3%)比较差异亦均无统计学意义(均P>0.05)。结论临床对拟行首次IVF-ET治疗且经阴道超声检查提示可疑子宫内膜息肉的患者,尤其是因心理因素迫切希望缩短治疗周期或在短时间内高度怀疑子宫内膜息肉复发的患者,可使用早卵泡期超长方案并在垂体降调节后行TCRP。Objective To compare the outcomes of in vitro fertilization-embryo transfer(IVF-ET) in patients undergoing transcervical resection of polyp(TCRP) before and after pituitary down-regulation. Methods A total of 228 infertile patients undergoing IVF for the first time with early follicular long protocol, received TCRP before fresh embryo transfer at the Reproductive Center of the Second Affiliated Hospital of Wenzhou Medical University from June 2016 to December 2017. The TCRP was performed before pituitary down-regulation in 117 cases(group Ⅰ) and after pituitary down-regulation in 111 cases(group Ⅱ). The reproductive outcomes of the two groups were compared. Results Patients in group Ⅰ underwent embryo transfer 44.26 ± 5.14 d after TCRP. While in group Ⅱ, embryo transfer was performed 80.03±6.87 d after TCRP. The Gn duration, Gn dosage, the number of retrieved eggs, endometrial thickness on embryo transfer day, the number and the type of transferred embryos were comparable between the two groups(P >0.05). There were no significant differences in implantation rate(40.4% vs 37.2%), clinical pregnancy rate(62.9% vs 58.1%), live birth rate(55.7% vs 49.5%), ectopic pregnancy rate(1.6% vs 1.9%), biochemical pregnancy rate(8.2% vs 9.7%), spontaneous abortion rate(9.8% vs 13.0%), multiple pregnancy rate(19.7% vs 27.8%) and IVF-ET cycle cancellation rate(17.1% vs 17.3%) between two groups(P >0.05). Conclusion For patients with suspected endometrial polyps under vaginal ultrasound and attempting their first IVF-ET treatment, especially in those who are eager to shorten the treatment period due to psychological factors or are highly suspected of recurrence of endometrial polyps in a short time, TCRP performed after pituitary down-regulation in early follicular long protocol is feasible.

关 键 词：子宫内膜息肉 宫腔镜下子宫内膜息肉摘除术 不孕症 妊娠结局 

分 类 号：R713.4[医药卫生—妇产科学] R714.8[医药卫生—临床医学]