Istishari Fertility Center, Istishari Hospital, PO Box 144733, Amman 11814, Jordan.
Reprod Biomed Online. 2010 Sep;21(3):373-80. doi: 10.1016/j.rbmo.2010.03.028. Epub 2010 Apr 8.
This study evaluated the results of a management protocol combining a number of investigations and interventions, previously proven beneficial in randomized controlled trials in IVF/intracytoplasmic sperm injection (ICSI) patients with apparently unexplained recurrent implantation failure (defined as two or more previous failed cycles, during which at least six good-quality embryos were transferred). It was a prospective cohort study and included 273 couples with previous recurrent implantation failure. Each patient (all under 40) underwent a pre-treatment work-up, consisting of pelvic ultrasound scan for hydrosalpinx, hysteroscopy and screening for acquired and congenital thrombophilia. Detected abnormalities were dealt with accordingly: proximal occlusion for hydrosalpinx, hysteroscopic management for intrauterine pathology and thromboprophylaxis with daily low-molecular weight heparin from the day of embryo transfer for thrombophilia. The patients then underwent IVF/ICSI with laser-assisted hatching. 112 patients (41%; group 1) had abnormalities detected (17 hydrosalpinx, 11 intrauterine pathology, 63 congenital thrombophilia, 21 acquired thrombophilia) and the remaining 161 (59%; group 2) had normal work-up. The pregnancy rates per cycle started for all patients, group 1 and group 2 were 47%, 55% and 41%, respectively. This suggests that using the described management protocol in couples with previous recurrent implantation failure leads to a favourable chance of success.
本研究评估了一种管理方案的结果，该方案结合了多项经证实对体外受精/卵胞浆内单精子注射（ICSI）中不明原因反复着床失败（定义为两次或更多次先前失败的周期，在此期间至少转移了 6 个优质胚胎）患者的随机对照试验有益的调查和干预措施。这是一项前瞻性队列研究，共纳入 273 对有不明原因反复着床失败病史的夫妇。每位患者（均未满 40 岁）均接受了预处理检查，包括用于输卵管积水的盆腔超声检查、宫腔镜检查和获得性及先天性血栓形成倾向的筛查。相应处理发现的异常：近端阻塞治疗输卵管积水，宫腔镜处理宫内病变，血栓形成倾向患者从胚胎移植日开始每日使用低分子肝素进行血栓预防。然后患者接受激光辅助孵化的体外受精/ICSI。112 名患者（41%；第 1 组）发现存在异常（17 例输卵管积水，11 例宫内病变，63 例先天性血栓形成倾向，21 例获得性血栓形成倾向），其余 161 名患者（59%；第 2 组）检查正常。所有患者、第 1 组和第 2 组的每个周期开始的妊娠率分别为 47%、55%和 41%。这表明，在有不明原因反复着床失败病史的夫妇中使用描述的管理方案可带来有利的成功机会。
