摘要
目的探讨高分化子宫内膜样癌(endometrial carcinoma, EC)及子宫内膜不典型增生(atypical endometrial hyperplasia, AEH)合并不孕患者在病变逆转后置入左炔诺孕酮宫内节育系统(曼月乐)再行体外受精(in vitro fertilization, IVF)助孕的临床策略可行性。方法回顾性分析了2018年3月至2019年12月期间就诊于中国医学科学院北京协和医院妇科内分泌与生殖中心的20例EC及AEH合并不孕症患者的临床资料。所有患者保守治疗成功后带曼月乐行IVF促排卵周期。取卵后胚胎培养至囊胚并冷冻,累积冷冻≥4枚囊胚后,所有患者取环并评估内膜组织学,观察冷冻周期移植囊胚的临床结局。结果患者中位年龄为33岁,内膜诊刮病理评估首次达完全缓解时间为4.3个月。共进行取卵周期34个,中位获卵数为8枚;共尝试解冻周期21个,实际可移植胚胎的周期为14个,5例临床妊娠,3例继续妊娠。结论对于内膜病变逆转后的EC及AEH合并不孕症患者,带曼月乐进行IVF时待获得足够囊胚后再取环移植可能是一种可行的助孕策略。
Objective To investigate the feasibility of a novel in vitro fertilization(IVF)strategy with levonorgestrel intrauterine system(Mirena)in situ in infertility patients after successful conservative treatment of early well-differentiated endometrial adenocarcinoma(EC)and atypical endometrial hyperplasia(AEH).Methods The clinical characteristics of infertility patients after a complete regression of previous EC and AEH who underwent IVF with a Mirena in situ from March 2018 to December 2019 in Center for Gynecological Endocrinology&Reproductive Medicine,Peking Union Medical College Hospital were retrospectively analyzed.These patients underwent one or more cycles to harvest at least 4 blastocysts cryopreserved,before removing the Mirena and re-evaluating the endometrium.Then the outcomes of frozen-thawed embryo transfer(FET)were commenced.Results A total of 20 patients were included with a median age of 33 years.The complete regression of endometrial lesion was achieved at 4.3 months.Thirty-four IVF cycles were conducted in total,leading to a median oocytes retrieved of 8.We had attempted 21 embryo trasfer but only 14 cycles were effective,and 5 patients got clinical pregnancy and 2 patients had ongoing pregnancy.Conclusion It is a supposedly practical way that IVF with the Mirena until pooling enough blastocysts before removing the device and initiating embryo trasfer for assisting reproduction and endometrial protection in patients after fertility-sparing treatment of EC or AEH.
作者
张多多
邓成艳
郁琦
潘凌亚
王含必
Zhang Duoduo;Deng Chengyan;Yu Qi;Pan Lingya;Wang Hanbi(Center for Gynecological Endocrinology&Reproductive Medicine,Peking Union Medical College Hospital,Beijing 100730,China)
出处
《中华生殖与避孕杂志》
CSCD
北大核心
2021年第3期237-241,共5页
Chinese Journal of Reproduction and Contraception
关键词
不孕症
子宫内膜样腺癌
子宫内膜不典型增生
受精
体外
胚胎移植
左炔诺孕酮宫内节育系统
Infertility
Endometrial adenocarcinoma
Endometrial hyperplasia with atypia
Fertilization in vitro
Embryo transfer
Levonorgestrel intrauterine system
