不同针灸预处理对反复体外受精联合胚胎移植失败者子宫内膜容受性的影响

【目的】观察反复体外受精联合胚胎移植(IVF-ET)失败者接受3种不同针灸预处理后子宫内膜容受性(ER)的变化情况,寻找调整ER最佳的针灸预处理方法。【方法】将90例反复IVF-ET失败后低ER、未行胚胎移植(ET)患者随机分为针刺组、电针组和温针组,每组各30例。针刺组在月经干净后卵泡期开始行普通针刺治疗,至排卵期停止,连续治疗3个月经周期;电针组在针刺组基础上行电针治疗;温针组在针刺组基础上行温针治疗。观察3组患者治疗前后子宫内膜形态、子宫内膜下血流类型的变化情况,比较3组患者的胚胎种植率和临床妊娠率。【结果】(1)治疗前,针刺组、电针组和温针组患者血促黄体生成素(LH)峰日内膜a型率和子宫内膜下血流A型率比较均分别为0.0%(0/30)、0.0%(0/30)和0.0%(0/30)],差异均无统计学意义(P>0.05)。治疗后,针刺组、电针组和温针组患者内膜a型率和A型率均分别为33.3%(10/30)、66.7%(20/30)和93.3%(28/30)]均明显高于治疗前(P<0.05),其中温针组内膜a型率和子宫内膜下血流A型率较针刺组和电针组明显提高,差异均有统计学意义(P<0.05)。(2)治疗后,温针组患者的胚胎种植率为23.3%(7/30),高于针刺组的13.3%(4/30)和电针组的16.7%(5/30),差异均有统计学意义(P<0.05)。(3)治疗后,温针组患者的临床妊娠率为46.7%(14/30),高于针刺组的26.7%(8/30)和电针组的33.3%(10/30),差异均有统计学意义(P<0.05)。【结论】在3种针灸预处理方法中,温针灸更能有效地改善反复IVF-ET失败患者的子宫内膜容受性,帮助其获得再次移植成功。

Effects of Acupuncture Pretreatment on Endometrial Receptivity of Patients with Repeated In-vitro Fertilization and Embryo Transfer Failure

Objective To observe the effects of three acupuncture pretreatment methods on the endometrial receptivity(ER)of the patients after repeated in-vitro fertilization and embryo transfer(IVF-ET)failure in different preconditioning,so as to optimize the acupuncture pretreatment method for improving ER.Methods Ninety patients suffering from repeated IVF-ET failure with low ER and having no embryo transfer(ET)were randomly divided into acupuncture group,electroacupuncture group and warming needle group,with 30 cases in each group.In the follicular phase after the end of menstruation,the three groups started the conventional acupuncture treatment,and the acupuncture stopped till the ovulation period.And additionally,the electroacupuncture group was given electroacupuncture therapy and the warming needle group was given warming needle therapy.The treatment for the three groups lasted 3 continuous menstrual cycles.Before and after treatment,the changes in endometrial morphology and subendometrial blood flow types of the three groups were observed.After treatment,the embryo implantation rate and clinical pregnancy rate in the three groups were evaluated.Results(1)Before treatment,the endometrium type a rate on luteinizing hormone(LH)peak day and the subendometrial blood flow type A rate in the three groups were all 0.0%(0/30),and the intergroup comparison showed that the difference among the three groups was insignificant(P>0.05).After treatment,the endometrium type a rate and the subendometrial blood flow type A rate in the acupuncture group were all 33.3%(10/30),in the electroacupuncture group were all 66.7%(20/30)and in the warming needle group were all 93.3%(28/30),which were much higher than those before treatment(P<0.05).And the warming needle group had the highest endometrium type a rate and subendometrial blood flow type A rate(P<0.05).(2)After treatment,the embryo implantation rate in the warming needle group was 23.3%(7/30),and was higher than that in the acupuncture group(13.3%,4/30)and in the electroacupuncture group(16.7%,5/30),the difference being statistically significant(P<0.05).(3)After treatment,clinical pregnancy rate in the warming needle group was 46.7%(14/30),and was higher than that in the acupuncture group(26.7%,8/30)and in the electroacupuncture group(33.3%,10/30),the difference being statistically significant(P<0.05).Conclusion Among the three acupuncture pretreatment methods,warming needle therapy can effectively improve the ER of the patients suffering from repeated IVF-ET failure,which is benificial to the successful retransplantation.