南方医科大学学报 ›› 2015, Vol. 35 ›› Issue (02): 248-.

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子宫腺肌病对体外受精-胚胎移植临床结局的影响

陶婷,陈士岭,陈薪,叶德盛,许丽娟,田小龙,刘玉东,牛静   

  • 出版日期:2015-02-20 发布日期:2015-02-20

Effects of uterine adenomyosis on clinical outcomes of infertility patients treated with in
vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET)

  • Online:2015-02-20 Published:2015-02-20

摘要: 目的探讨子宫腺肌病对不孕患者体外受精-胚胎移植(IVF/ICSI-ET)临床结局的影响及其可能的原因。方法回顾性分
析南方医院经阴道超声诊断为子宫腺肌病患者61个IVF/ICSI周期作为研究组,对照组为164例单纯输卵管性不孕患者。对两
组的一般情况、控制性促排卵过程中的卵巢反应性、胚胎着床率、临床妊娠率、早期流产率、活产率等进行分析。结果研究组的
新鲜周期胚胎着床率、临床妊娠率、活产率均显著低于对照组(P<0.05),早期流产率显著高于对照组(P<0.05)。研究组中,与
GnRHa降调节的长方案相比,GnRH拮抗剂方案对临床妊娠率、早期流产率均有不利影响(25.0% vs 45.0%,P=0.184;66.7% vs
27.8%,P=0.247),但无统计学差异,而活产率显著低于长方案组患者(0% vs 30.8%,P=0.025)。结论子宫腺肌病降低不孕患者
IVF/ICSI-ET的胚胎着床率、临床妊娠率、活产率,且增加流产率,GnRH拮抗剂方案对子宫腺肌病患者IVF/ICSI-ET的临床结局
有负面影响,GnRHa长方案能够增加IVF/ICSI-ET的临床妊娠率、降低流产率。

Abstract: Objective To explore the effects of uterine adenomyosis on the clinical outcomes of infertility patients treated with in
vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET). Methods A retrospective study was
conducted of 61 IVF/ICSI-ET cycles as the study group, diagnosed with uterine adenomyosis by transvaginal ultrasound, and
164 IVF/ICSI-ET cycles of patients with tubal infertility as the control group. The baseline characteristics, ovary response and
clinical outcomes were compared between the two groups. Results The implantation rate, clinical pregnancy rate and live birth
rate decreased significantly in the study group (P<0.05), and early abortion rate increased significantly (P<0.05). For patients
with adenomyosis, GnRH-antagonist cycles tended to decrease clinical pregnancy rate and increase abortion rate (25.0% vs
45.0%, P=0.184; 66.7% vs 27.8%, P=0.247), and significantly decrease live birth rate (0% vs 30.8%, P=0.025), compared with
GnRHa agonist cycles. Conclusion Uterine adenomyosis decreases implantation rate, clinical pregnancy rate and birth rate,
and increases abortion rate significantly in patients with IVF/ICSI-ET. GnRH-antagonist cycles have adverse effects on the
outcomes of adenomyosis; GnRH agonist long protocol cycles may increase clinical pregnancy rate and decrease abortion rate.