子宫内膜异位症体外受精移植未见原核胚胎成功妊娠一例

doi:10.12280/gjszjk.20210246

摘要/Abstract

摘要：

报告1例因输卵管粘连分离+输卵管伞端造口术+子宫内膜异位病灶清除术后的患者,采用辅助生殖技术助孕,移植未见原核胚胎后成功妊娠。患者因输卵管粘连分离+输卵管伞端造口术+子宫内膜异位病灶清除术后6个月余未孕,于2018年10月采用超长方案后获得2枚未见原核胚胎,并于2019年1月采用亮丙瑞林3.75 mg降调节后替代周期冻融胚胎移植后妊娠,妊娠期严密随访最终获得活产女婴。该病例启发临床医生对于子宫内膜异位症患者选择助孕方案的个体化思考,同时对未见原核胚胎临床利用的利弊进行了探索,以期最终获得满意的妊娠结局。

关键词: 生殖技术,辅助, 亮丙瑞林, 子宫内膜异位症, 子宫腺肌病, 未见原核胚胎

Abstract:

This is a case report of successful pregnancy after the frozen embryo transfer of non-pronuclcus embryos, in which the patient with postoperative endometriosis underwent the treatment of assisted reproductive technology (ART). Six months ago, the patient had the comprehensive operation of the separation of fallopian tube adhesion, the fistulation of tubal fimbria and the debridement of endometriosis debridement. In October 2018, two non-pronuclcus embryos were obtained after the ultra-long protocol. Leuprorelin (3.75 mg) was used in January 2019 (for 3 cycles) to prepare endometrium for frozen-thawed embryo transfer (FET), under the informed consent. Eventually, the patient gave birth to a healthy baby girl. This case inspires the individualized consideration on the choice of assisted pregnancy scheme for patients with endometriosis, and the exploration on the advantages and disadvantages of clinical use of non-pronuclcus embryos in order to obtain satisfactory pregnancy outcomes.

Key words: Reproductive techniques,assisted, Leuprolide, Endometriosis, Adenomyosis, Non-pronuclcus embryos

兰云竹, 王芳, 黄桂英, 陈绍威. 子宫内膜异位症体外受精移植未见原核胚胎成功妊娠一例[J]. 国际生殖健康/计划生育, 2022, 41(1): 22-24.

LAN Yun-zhu, WANG Fang, HUANG Gui-ying, CHEN Shao-wei. A Successful Pregnancy after Embryo Transfer of Non-Pronuclcus Embryos in Patient with Postoperative Endometriosis[J]. Journal of International Reproductive Health/Family Planning, 2022, 41(1): 22-24.

图/表 8

参考文献 12

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日期	E₂ （pmol/L）	P （nmol/L）	LH （U/L）	FSH （U/L）	CA125 （U/mL）
2018.10.20	89.89	2.28	2.53	9.32	399.55
2018.11.23	46.12	1.65	0.46	6.05	146.28
2018.12.21	73.75	2.47	-	-	57.52
2019.01.02	5 355.06	2.69	0.73	-	-

日期	E₂ （pmol/L）	P （nmol/L）	LH （U/L）	FSH （U/L）	CA125 （U/mL）
2018.10.20	89.89	2.28	2.53	9.32	399.55
2018.11.23	46.12	1.65	0.46	6.05	146.28
2018.12.21	73.75	2.47	-	-	57.52
2019.01.02	5 355.06	2.69	0.73	-	-

日期	B超情况
2018.10.20	左卵巢直径<10 mm卵泡3枚,右卵巢<10 mm卵泡5枚
2018.11.23	内膜显示不清,左卵巢38 mm×27 mm液性暗区?右卵巢2~3 mm卵泡5枚,25 mm×15 mm、16 mm×8 mm、34 mm×18 mm不均质强回声包块待排查
2018.12.21	内膜4 mm,左卵巢16 mm×12 mm液性暗区?4~5 mm卵泡3枚,2 mm卵泡1枚;右卵巢29 mm×30 mm不均质强回声包块?（考虑卵巢子宫内膜异位囊肿）,4~5 mm卵泡3枚,2~3 mm卵泡2枚
2019.01.02	内膜8.6 mm,>18 mm卵泡2枚,>16 mm卵泡1枚,>14 mm卵泡1枚,>12 mm卵泡1枚

日期	B超情况
2018.10.20	左卵巢直径<10 mm卵泡3枚,右卵巢<10 mm卵泡5枚
2018.11.23	内膜显示不清,左卵巢38 mm×27 mm液性暗区?右卵巢2~3 mm卵泡5枚,25 mm×15 mm、16 mm×8 mm、34 mm×18 mm不均质强回声包块待排查
2018.12.21	内膜4 mm,左卵巢16 mm×12 mm液性暗区?4~5 mm卵泡3枚,2 mm卵泡1枚;右卵巢29 mm×30 mm不均质强回声包块?（考虑卵巢子宫内膜异位囊肿）,4~5 mm卵泡3枚,2~3 mm卵泡2枚
2019.01.02	内膜8.6 mm,>18 mm卵泡2枚,>16 mm卵泡1枚,>14 mm卵泡1枚,>12 mm卵泡1枚

日期	E₂ （pmol/L）	P （nmol/L）	LH （U/L）	FSH （U/L）	CA125 （U/mL）
2019.01.14	135.60	2.16	6.14	0.20	332.17
2019.02.12	88.09	1.39	9.22	0.20	-
2019.03.13	91.68	1.24	-	-	53.46
2019.04.11	57.21	1.33	0.20	11.83	20.44
2019.05.13	3 120.48	2.31	-	-	-