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目的探讨提高体外受精-胚胎移植(IVF-ET)妊娠率的有效方法与策略。方法2003-05-2005-06上海交通大学医学院附属瑞金医院生殖医学中心对进行IVF-ET的患者固定相关条件,采用超声下胚胎移植、雌二醇(E2)/孕酮(P)监测调控注射人绒毛膜促性腺激素(HCG)的时机及助孕术前行子宫内膜搔刮术,观察其对妊娠结局的影响。结果超声下发现胚胎移植(ET)日子宫位置较预探有变化者占45.69%,其中深度增减超过5mm者达23.28%,其单胚种植率升高,两者比较差异有显著性意义。HCG日E2/P比值在3.01~4.00者妊娠率最高,<1者无妊娠。超声观察子宫内膜形态不良者经搔刮术转为规则三线征者占63.64%,获得了与内膜形态良好患者相近的临床结局;经上述措施,临床妊娠率及单胚种植率逐年提高,最高达到53.85%和31.88%。结论超声下ET和助孕术前子宫内膜搔刮术,对提高IVF-ET妊娠率显示了有效的价值,E2/P监测调控注射HCG时机的效果有待样本积累。
Objective To explore effective methods and strategies for improving the pregnancy rate of IVF-ET. Methods 2003-05-2005-06 Reproductive Medicine Center of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine fixed-related conditions of patients undergoing IVF-ET, under the control of ultrasound embryo transfer, estradiol (E2) / progesterone (P) monitoring The timing of injection of human chorionic gonadotropin (HCG) and endometrial stripping curettage before pregnancy, to observe its impact on pregnancy outcome. Results Ultrasound showed that the location of the uterus on embryonic day (ET) was 45.69% compared with the pre-exploration, and the depth of single embryo implantation rate was 23.28%, the difference was significant between the two groups. HCG day E2 / P ratio of 3.01 ~ 4.00, the highest pregnancy rate, <1 no pregnancy. Ultrasound observation of endometrial dysplasia by scraping surgery to the rule of the three line sign accounted for 63.64%, obtained with the endometrial good patients similar clinical outcomes; the above measures, the clinical pregnancy rate and single embryo implantation rate increased year by year, Up to 53.85% and 31.88%. Conclusions ET and endometrial scraping before pregnancy can show an effective value in improving the pregnancy rate of IVF-ET. The effect of E2 / P monitoring on the timing of HCG injection needs to be accumulated.