先天性子宫畸形不孕患者行IVF-ET的临床结局分析

Analysis of Clinical Outcome of IVF-ET in Infertile Patients with Congenital Uterine Malformations

摘要: 目的：通过对比先天性子宫畸形与正常形态子宫不孕患者接受IVF/ICSI-ET治疗的实验室和临床结局，探讨子宫畸形对助孕技术的影响。方法：收集我院2011年至2020年收治的先天性子宫畸形患者119例(共320个周期)为子宫畸形组，选取同期因其他因素行IVF/ICSI治疗且子宫形态正常的357例患者(共570个周期)作为对照组，回顾性分析两组患者一般资料、实验室指标及临床妊娠结局。并将纵膈子宫组患者按照是否接受手术治疗分为两个亚组，比较两组间的一般情况、实验室指标及临床妊娠结局。结果：畸形组和对照组两组患者的一般资料、Gn天数、Gn用量、获卵数、移植胚胎数、优质胚胎数、种植率、临床妊娠率、宫外妊娠率、分娩孕周比较无显著性差异(P > 0.05)，但与对照组相比，畸形组的流产率与早产率显著升高，差异具有统计学意义(P < 0.05)。纵膈子宫未手术组和手术组的一般情况、实验室指标及临床妊娠结局均无统计学差异。结论：子宫畸形不影响患者的卵巢反应和胚胎的实验室培养结果，合并子宫畸形的不孕患者流产率和早产率高于子宫形态正常患者，因此要重视子宫畸形患者的早期诊断和临床处理，加强孕期保健，以期改善临床结局，子宫畸形患者助孕前是否接受手术治疗要结合患者情况综合考虑。

Abstract: Objective: By comparing the laboratory and clinical outcomes of infertile patients with congenital uterine malformation and normal uterus receiving IVF/ICSI-ET, we investigate the effect of uterine malformation on pregnancy-assisted technology. Methods: A total of 119 patients with congenital uterine malformations (320 cycles in total) admitted to our hospital from 2011 to 2020 were selected as the uterine malformation group. In the same period, 357 patients with normal uterine morphology (570 cycles in total) who underwent IVF/ICSI treatment due to other factors were selected as a control group, retrospectively analyze the general data, laboratory indicators and clinical pregnancy outcomes of the two groups of patients. The patients in the mediastinal uterus group were divided into two subgroups according to whether they received surgical treatment, and the general conditions, laboratory indicators and clinical pregnancy outcomes between the two groups were compared. Results: There was no significant difference between the deformity group and the control group in general information, Gn days, Gn dosage, number of eggs obtained, number of embryos transferred, number of high-quality embryos, implantation rate, clinical pregnancy rate, ectopic pregnancy rate, and gestational week of delivery (P > 0.05), but compared with the control group, the abortion rate and preterm birth rate of the deformity group were significantly higher. The difference was statistically significant (P < 0.05). There was no statistical difference in general conditions, laboratory indicators and clinical pregnancy outcomes between the mediastinal uterus non-operation group and the operation group. Conclusion: Uterine malformations do not affect the patient’s ovarian response and embryo laboratory culture results. Infertility patients with uterine malformations have higher abortion and preterm birth rates than those with normal uterine morphology. Therefore, early diagnosis and clinical treatment of patients with uterine malformations should be emphasized and strengthened. Health care during pregnancy in order to improve the clinical outcome, whether or not patients with uterine malformations receive surgical treatment before fertilization should be considered in combination with the patient’s condition.