Mesrogli M, Nitsche U, Maas D H, Degenhardt F, Dieterle S, Schlösser H W
Zentrum für Frauenheilkunde, Medizinische Hochschule Hannover.
Geburtshilfe Frauenheilkd. 1991 Sep;51(9):688-93. doi: 10.1055/s-2007-1023817.
The high rate of implantation failures in infertile patients after in vitro fertilization must be regarded as the major problem of the kind of treatment. Usually, no information on the development of the embryo can be obtained for the time between embryo replacement and rising beta-hCG levels. Own studies on the early pregnancy factor (EPF) showed a positive reaction few hours following the contact of a fertilized oocyte with the endometrial surface. Therefore, we used the EPF as a marker for the viability of the embryo in 82 patients after in vitro fertilization and embryo transfer. Within two days after embryo transfer the EPF was positive in 52 (63%) patients and negative in 30 (37%) patients. In these women the embryos may have been lost during handling or may have discontinued further development. Between day 3 and day 12 after transfer the EPF turned to negative values in 35 patients--especially between day 6 and 10. These cases must be regarded as true implantation failures. After day 12 following embryo transfer, rising beta-hCG levels could be measured in 17 women (21%), but only in 12 patients (15%) could a growing embryonic sac be detected by ultrasound. From these figures, we may conclude, that about half of the embryos are lost already during the step of embryo transfer and the other half during implantation. Therefore, more attention should be given to the handling of the embryos to increase the pregnancy rate after in vitro fertilization.
体外受精后不孕患者的高着床失败率必须被视为这类治疗的主要问题。通常，在胚胎移植后至β-人绒毛膜促性腺激素（β-hCG）水平升高这段时间内，无法获得胚胎发育的相关信息。我们自己关于早期妊娠因子（EPF）的研究表明，受精卵与子宫内膜表面接触后数小时会出现阳性反应。因此，我们将EPF用作82例体外受精和胚胎移植后患者胚胎活力的标志物。胚胎移植后两天内，52例（63%）患者的EPF呈阳性，30例（37%）患者的EPF呈阴性。在这些女性中，胚胎可能在操作过程中丢失，或者可能停止了进一步发育。移植后第3天至第12天期间，35例患者的EPF转为负值，尤其是在第6天至第10天之间。这些病例必须被视为真正的着床失败。胚胎移植后第12天之后，17名女性（21%）可检测到β-hCG水平升高，但只有12例患者（15%）通过超声检测到有正在生长的孕囊。从这些数据中，我们可以得出结论，大约一半的胚胎在胚胎移植过程中就已丢失，另一半在着床过程中丢失。因此，为提高体外受精后的妊娠率，应更加注意胚胎的操作。
