反复胚胎种植失败妇女的临床特点分析

夏婷婷李洁

【摘要】目的探讨反复胚胎种植失败(RIF)妇女的临床特点。方法收集体外受精-胚胎移植(IVF-ET)治疗的774例不孕妇女，其中RIF妇女109例(RIF组)，首次行新鲜胚胎移植妊娠妇女665例(对照组)。比较2组妇女的年龄、不孕年限、BMI、不孕类型、不孕原因、基础激素、受精方式和促排卵方案等。结果与对照组相比，RIF组妇女的年龄较高，不孕年限较长，双方因素、子宫内膜异位症(EMS)引起的不孕者比例以及使用促性腺激素释放激素(GnRH)激动剂短方案、GnRH拮抗剂方案、单纯氯米芬/促性腺激素促排卵方案者比例较高(P均<0.05)；2组间不孕类型、BMI、血清基础卵泡刺激素、黄体生成素、雌激素水平及受精方式比较差异均无统计学意义(P均>0.05)。RIF妇女中，染色体检查结果异常者占7.8%，宫腔镜检查结果异常者占54.8%。结论部分RIF妇女存在染色体G带和宫腔异常，高龄和EMS患者易发生RIF。

【关键词】反复胚胎种植失败；子宫内膜异位症；背景资料

收稿日期：(2015-04-30)

DOI：10.3969/g.issn.0253-9802.2015.10.013

通讯作者，欧阳颖，E-mail：oyying8888@sina.com

Analysis of clinical characteristics of women with repeated implantation failureXiaTingting，LiJie.DepartmentofInfertility&SexualMedicine,theThirdAffiliatedHospitalofSunYat-senUniversity,Guangzhou510630,China

Correspondingauthor,LiJie

Abstract【】ObjectiveTo analyze the clinical characteritics of women with repeated implantation failure (RIF). MethodsA total of 774 women undergoing in vitro fertilization and embryo transfer (IVF-ET) were recruited in this study. Among them, 109 women had a history of RIF (RIF group) and 665 were pregnant individuals receiving fresh embryo transfer for the first time (control group). Age, duration of infertility, body mass index (BMI), type of infertility, cause of infertility, basic hormone, insemination method and ovulation induction protocol were statistically compared between two groups. ResultsCompared with the control group, patients in the RIF group were older, had a longer history of infertility, higher proportion of infertility caused by both male and femal factors and endometriosis (EMS), and higher percentage of use of gonadotropin-releasing hormone-a (GnRH-a) short protocol, GnRH antagonist protocol and clomiphene/ ovulation induction (all P<0.05). Type of infertility, BMI, levels of serum basal follicle-stimulating hormone, luteinizing hormone and estrogen, and insemination method did not significantly differ between two groups (all P>0.05). In the RIF group, 7.8% of patients had chromesome abnormality and 54.8% presented with abnormal outcomes detected by hysteroscopy. ConclusionsPartial RIF women were found to have abnormal G-banding karyotype and uterine cavity abnormality. Women with EMS andolder age are prone to developing RIF.

【Key words】Repeated implantation failure;Endometriosis; Background data

近年来，尽管体外受精和胚胎培养技术的发展使得临床上能够选择多个具有发育潜能的胚胎移植，但仍然存在部分妇女反复胚胎种植失败(RIF)，胚胎种植率始终处于较低水平。RIF的定义尚未明确，Margalioth等(2006年)将移植优质胚胎至少3个周期未能成功种植定义为RIF，其发生率约为19%。也有报道认为，由于每个中心的患者年龄段及采用的治疗方案不同，比如采用自然周期的周期妊娠率低于促排卵周期，因此每个中心可以根据本中心的妊娠状况制定RIF标准[1]。RIF发生的原因包括子宫内膜、胚胎及两者相互作用3个方面，但还有很多未知的原因。……