生殖医学杂志

目的对行体外受精助孕的原发性不育患者的病因进行分析,了解各病因所占的比例,并比较各组患者妊娠结局。方法对行体外受精的原发性不育患者按病因分为输卵管因素、男方因素、子宫内膜异位症(内异症)、排卵障碍和不明原因不育组,计算各组患者在总患者中的比例;比较各组卵泡刺激素(Gn)用量、获卵数、受精率、卵裂率、优质胚胎率、胚胎种植率、临床妊娠率及流产率。结果输卵管因素在原发性不育患者中比例最高(46.14%),其次是男方因素(30.48%);Gn用量男方因素组和排卵障碍组较少,与输卵管因素组比较有显著性差异(P<0.05);获卵数男方因素组最高,其次是排卵障碍组,与输卵管因素组比较无显著差异(P>0.05),内异症组获卵数最低,与输卵管因素组相比有显著性差异(P<0.05);排卵障碍组的受精率、卵裂率、优质胚胎率均最高,内异症组最低,但各组之间无显著性差异(P>0.05);胚胎种植率排卵障碍组最高(40.44%),输卵管因素组最低(18.44%);临床妊娠率内异症组和排卵障碍组分别为40.43%和36.67%,其次是男方因素组为34.50%,不明原因不育组为29.63%和输卵管因素组最低为26.86%;不明原因不育组的流产率最高为25%,内异症组和输卵管因素组各发生1例异位妊娠。结论输卵管因素在原发性不育患者中比例最高,其临床妊娠率低可能与内膜炎症和输卵管积水有关,子宫内膜异位症行预处理可获得较高的临床妊娠率。

Objective:To rank the causes of the primary infertility and compare the pregnancy outcomes of the patients with different etiology following in vitro fertilization and embryo transfer(IVF-ET).Methods:According to the cause of infertility,the patients were divided into five groups:tubal factor,male factor,endometriosis,ovulation failure and unexplained infertility.Then we calculated the constituent ratio of each group and recorded the dose of gonadotrophin administrated,the number of oocytes retrieved,fertilization rate,cleavage rate,high quality embryo rate,implantation rate,clinical pregnancy rate and the abortion rate.Results:The major cause of primary infertility was the tubal problems(46.14%),followed by male factor(30.48%).The dose of gonadotrophins administered was significantly lower in male factor group and ovulation failure group than that in tubal factor group(P<0.05).The number of oocytes retrieved in male factor group was the highest,but there was not significantly different from that in the tubal factor group.And the number of oocytes retrieved in the endometriosis group was the lowest among groups,and significantly lower than that in tubal factor group(P<0.05).Fertilization rate,cleavage rate and high quality embryo rate in ovulation failure group were 76.77%,94.89% and 40.44%,respectively,the highest among groups,while these rates in endometriosis group were the lowest(67.98%,92.55% and 29.98%,respectively).But there was no significant difference among groups(P>0.05).The implantation rate was the highest in endometriosis group(29.91%),while the lowest in the tubal factor group(18.44%).As for the clinical pregnancy rate,the endometriosis and ovulation failure group were outstanding,followed by male factor group.In unexplained infertility group,the abortion rate was as highly as 25%.Ectopic pregnancy was observed in endometriosis and tubal factor group.Conclusions:Tubal problem was the major cause of primary infertility and its low clinical pregnancy rate was probably related to endomembrane inflammation and hydrosalpinx.The pretreatment for the patients with endometriosis-associated infertility could achieve higher clinical pregnancy rate.