子宫内膜异位症合并不孕行辅助生殖助孕的结局分析

发布时间：2018-06-18 02:37

  本文选题：子官内膜异位症相关性不孕 + 超长方案　； 参考：《浙江大学》2017年硕士论文

【摘要】：目的分析子宫内膜异位症合并不孕后行辅助生殖技术助孕后的产科结局,探讨影响其疗效的可能相关因素。方法回顾性分析本中心2010.01～2013.12期间行辅助生殖技术助孕治疗的夫妇,研究组为子宫内膜异位症合并不孕病人,分析其临床、实验室及随访资料,并分析其结局。结果1.相同促排方案下,内异Ⅰ～Ⅱ期组原发不孕率(70.12%)及内异Ⅲ～Ⅳ期组原发不孕率(73.42%)均显著高于同期管性组水平(39.02%)(P0.01);内异Ⅲ～Ⅳ期组Gn用量(2435.89±955.62)相比于内异Ⅰ～Ⅱ期组增加(2270.95±994.11)(P0.05),FSH 用量增加(2200.30±728.99 vs 1996.49±946.99)(P0.05),HMG 用量增加(219.63±344.96vs180.92±371.31)(P0.05),Gn 天数变长(11.00±2.12vs 9.82±1.67)(P0.05),获卵个数减少(10.94±5.69vs12.17±6.20)(P0.05)。正常受精率(63.58%vs 67.73%)及优质胚胎率(44.09%vs 48.30%)有下降的趋势,但无明显统计学差异(P0.05)。注射HCG日E2水平显著降低(10057.31±6098.07 vs 12588.59±6358.40)(P0.05)。内异Ⅰ～Ⅱ期组与管性组相比HMG用量少于管性组(180.92±371.31 vs211.05±336.01)(P0.05)。2.单纯卵巢型内异的Gn用量(2637.13±1122.44)要高于单纯腹膜型内异(2273.60±967.34)和混合型内异(2303.58±886.02)(P0.05);单纯卵巢型内异HMG用量(268.35±451.92)最大,混合型内异次之(200.00±288.96),单纯腹膜性内异用量(172.10±363.24)最少(P0.05);注射HCG日E2水平单纯卵巢型内异(9215.21±4889.14)要低于单纯腹膜型内异(11938.12±6494.39)和混合型内异(11642.98±6314.00)(P0.05),单纯腹膜型内异组获卵个数(12.53±6.15)要高于单纯卵巢型内异(10.81±6.34)和混合型内异(10.71±5.40)(P0.05);单纯腹膜型内异受精率最高(68.58%),卵巢型内异次之(63.33%),混合型内异(61.62%)最低(P0.05);卵巢型内异的流产率(10.00%)要高于腹膜型内异(3.38%)和混合型内异(3.51%)(P0.05)。3.内异超长方案组相比于内异长方案组Gn用量较大(P0.05),FSH用量较大(P0.05),HMG用量较大(P0.01),Gn天数延长但是无统计学差异,注射HCG日E2水平明显较低(P0.01),且获卵个数较少(P0.05);但受精率较高,优胚率较低,胚胎种植率较高,但无统计学差异(P0.05)。超长组临床妊娠率高于长方案促排组(P0.05)。4.长方案内异组与管性组相比,胎盘异常的发生率要高且有统计学意义(P0.05)。结论相同促排方案下内异症患者相比于管性患者随着其分期的升高,药物用量增加,获卵个数减少,受精率减少,优胚率减少,活产率减少,患者孕期胎盘异常的发生率要高,但新生儿情况与母体余妊娠并发症并明显差异。卵巢型内异药物用量要多于混合型内异及腹膜型内异,且获卵个数最少,受精率最低,卵巢型内异的流产率最高。对于内异患者,超长方案虽在一定程度上增加其药物的用量,但能够提高其妊娠成功率,在一定程度上改善妊娠结局。
[Abstract]:Objective to analyze the obstetrical outcome of endometriosis complicated with infertility and explore the possible factors affecting the outcome of assisted reproductive technology. Methods A retrospective analysis of the couples who were treated with assisted reproductive technology during the period of 2010.01 and 2013.12 in our center. The study group was a case of endometriosis complicated with infertility. The clinical, laboratory and follow-up data were analyzed, and the outcome of the study group was analyzed. Result 1. Under the same emission promotion scheme, The rate of primary infertility in stage 鈪，

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