反复着床失败的治疗现状与进展

反复着床失败(repeated implantation failure,RIF)是指经历多个体外受精/胞浆内单精子注射(IVF/ICSI)周期并移植了多枚优质胚胎而出现的临床妊娠失败,其原因多而复杂,母体方面因素包括子宫解剖结构异常、子宫内膜容受性低及母胚免疫异常等多个方面,胚胎方面因素则包括胚胎遗传物质缺陷、胚胎孵化不良、胚胎培养环境不良、胚胎移植操作不当。如何针对RIF的原因进行正确的干预是改善预后的关键,对于解剖结构异常可采用手术进行矫正,为提高子宫内膜容受性可采用增加内膜厚度、抑制频繁宫缩、改善凝血功能、调整免疫状态、刺激内膜应答等,胚胎方面则需要筛选优质胚胎、辅助胚胎孵化、改进移植技巧。现就各种因素RIF的相应干预措施及进展进行归纳和综述。

Treatment of Repeated Implantation Failure

Repeated implantation failure (RIF) refers to the failure of achieving a clinical pregnancy after transferring several good-quality embryos in several IVF/ICSI cycles. The causes are complicated, including abnormal anatomical structure, bad receptivity of endometrium, and disorder of immune state in matrix, and abnormal hereditary substance, inappropriate incubation and implantation in embryo. How to detect the exact causes of RIF and how to pre-treat appropriately are the key to improve the prognosis of RIF. The abnormal anatomical structure can be corrected through surgery. The endometrial receptivity can be improved by increasing endometrial thickness, suppressing frequent uterine contraction, and regulating coagulation function and immune state. The success rate of embryonic transfer can be improved by screening good-qualify embryos, assisting hatching embryos and improving implanting skills. We discussed the causes of RIF and treatment progress in this paper.