Noyes N, Licciardi F, Grifo J, Krey L, Berkeley A
New York University Program for In Vitro Fertilization, Infertility, and Reproductive Surgery, New York University Medical Center, New York 10016, USA.
Fertil Steril. 1999 Aug;72(2):261-5. doi: 10.1016/s0015-0282(99)00235-6.
To assess the impact of ET difficulty on IVF outcome and to optimize the ET procedure.
Retrospective analysis of IVF outcome by ET catheter type and ET difficulty. Prospective treatment and follow-up of patients with a history of extremely difficult cervical passage.
Large university-based IVF program.
PATIENT(S): All patients < 40 years of age undergoing IVF-ET from September 1995 to May 1998.
INTERVENTION(S): Surgical correction of cervical stenosis.
MAIN OUTCOME MEASURE(S): Pregnancy and embryo implantation rates.
RESULT(S): Only 0.6% of ETs were "extremely difficult." Pregnancy rates were not statistically significantly different among ETs graded easy, moderate, and difficult. In contrast, no pregnancies occurred in the rare "extremely difficult" ET group. Eight patients with a history of extremely difficult cervical passage underwent surgical correction of their cervical stenosis. Twelve postoperative IVF-ET in these women resulted in eight clinical pregnancies, six of which were multiple gestations. The embryo implantation rate of these cycles was 42.2%.
CONCLUSION(S): Patients with a history of extremely difficult ET may benefit from hysteroscopic evaluation and possible modification of their cervical canal before a future IVF attempt.
评估胚胎移植（ET）难度对体外受精（IVF）结局的影响，并优化ET操作程序。
根据ET导管类型和ET难度对IVF结局进行回顾性分析。对有宫颈通道极度困难病史的患者进行前瞻性治疗和随访。
大型大学附属医院的IVF项目。
1995年9月至1998年5月期间所有年龄小于40岁接受IVF-ET的患者。
宫颈狭窄的手术矫正。
妊娠率和胚胎着床率。
仅0.6%的ET为“极度困难”。在分为容易、中等和困难等级的ET中，妊娠率在统计学上无显著差异。相比之下，罕见的“极度困难”ET组未发生妊娠。8例有宫颈通道极度困难病史的患者接受了宫颈狭窄的手术矫正。这些女性术后进行了12次IVF-ET，其中8次临床妊娠，6次为多胎妊娠。这些周期的胚胎着床率为42.2%。
有ET极度困难病史的患者在未来尝试IVF前，可能从宫腔镜评估及宫颈管的可能修正中获益。
