寿胎丸对提高体外受精-胚胎移植临床妊娠率的影响

                 作者：许志芃,单志群,潘纪华,刘小婷

【摘要】  目的 观察寿胎丸加味对提高体外受精-胚胎移植(IVF-ET)临床妊娠率的影响。方法 将2001－2003年中山医科大学深圳泌尿外科医院试管婴儿生殖中心采用IVF-ET助孕术后的有随访条件者80例随机分为2组,治疗组40例,对照组40例,治疗组自胚胎移植后除常规肌注黄体酮外运用中医辨证辅助治疗,对照组仅常规肌注黄体酮,不予其他干预,对2组疗效进行观察和比较。结果 治疗组40例,妊娠23例,临床妊娠率57.5%,平均孕激素水平(22.45±1.31)μg/L,妊娠流产率13.0%。对照组40例,妊娠12例,临床妊娠率30.0%,平均孕激素水平(10.18±0.89)μg/L,妊娠流产率25.0%,2组临床妊娠率、平均孕激素水平、妊娠流产率差异有统计学意义(P＜0.05,P＜0.01,P＜0.05)。结论 运用寿胎丸为基础方辨证治疗对提高IVF-ET临床妊娠率、降低妊娠流产率疗效显著优于单纯用黄体酮治疗。

【关键词】  体外受精；胚胎移植；辨证论治；寿胎丸

    Abstract：Objective To observe the effect of Shoutaiwan on improving clinical pregnancy rate of in vitro fertilization-embryo transfer (IVF-ET). Method Eighty people, who were easy to be followed up and pregnant with the assistant of IVF-ET by the tube-baby centre of Shenzhen Urology Surgical Hospital of Zhongshan Medical University from 2001 to 2003, were divided into two groups randomly with 40 people for each. Treatment group, after embryo transfer, were normally injected progesterone and auxiliary treated of traditional Chinese Medicine according to syndrome differentiation. The comparing group were only injected progesterone. The curative effect was observed and compared. Result In 40 cases of treatment group, 23 cases were pregnant, clinical pregnant rate was 57.5%, the average level of progesterone was (22.45±1.31)μg/L, pregnant abortion rate was 13.0%. In 40 cases of comparing group, 12 cases were pregnant, clinical pregnant rate was 30.0%, the average level of progesterone was (10.18±0.89)μg/L, pregnant abortion rate was 25%. There were significant differences in the clinical pregnant statistical rate, the average level of progesterone and pregnant abortion rate between the two groups. Conclusion It’s more effective that the syndrome differentiation method based on Shoutaiwan than progesterone treatment only in improving clinical pregnant rate and reducing pregnant abortion rate of IVF-ET.
   
　　Key words：in vitro fertilization；embryo transfer；syndrome differentiation；Shoutaiwan
 
    体外受精-胚胎移植(IVF-ET)技术俗称试管婴儿,是指从活体内取出卵子和精子经体外受精、培养,分裂成2～8个分裂球或胚泡期时,再移植到女性子宫内着床,发育成胎儿、分娩。该技术给许多不孕夫妇带来了福音,但即使形态良好的胚胎移植入子宫腔,IVF-ET的妊娠率仍很低。本院妇科与中山医科大学深圳泌尿外科医院试管婴儿生殖中心共同协作,在IVF-ET后运用中药辅助治疗,为提高IVF-ET的临床妊娠率寻找有效途径。

　　1  资料与方法

　　1.1  体外受精-胚胎移植助孕术

    采用促性腺激素激动剂(GnRH-α)降调节的长方案,于黄体中期予GnRH-α1.8 mg肌注,下次月经周期的第３日予肌注重组人促卵泡素(rhFSH)150～450 IU,定期监测B超及尿促黄体生成素(LH),卵子发育成熟时予绒毛膜促性腺激素(HCG) 10 000 IU肌注；肌注HCG 34～36 h后在阴道B超引导下经阴道穿刺负压抽吸取卵术,记录获卵数；女方取卵当天,男方取精,行常规IVF卵子培养4～6 h后受精,16～18 h后去卵丘细胞记录受精情况。取卵后72 h评判胚胎分级。一级胚胎：≥7个卵裂球,碎片＜10%；二级胚胎：7个＞卵裂球≥6个,20%＞碎片≥10%；三级胚胎：6个＞卵裂球≥5个,30%＞碎片≥20%；四级胚胎：卵裂球＜5个,碎片＞30%。一级及二级胚胎为优质胚胎,取卵后7 h进行胚胎移植,取卵日起肌注黄体酮40 mg/d。

　　1.2  一般资料

    将2001－2003年中山医科大学深圳泌尿外科医院试管婴儿生殖中心采用IVF-ET助孕术后的有随访条件者80例随机分为2组。治疗组40例,对照组40例,年龄28～42岁,平均35岁,病程3～13年,均为做过IVF-ET助孕术1次以上未成功者,排除染色体异常、免疫性不孕及男方因素,2组间临床资料数据比较差异无统计学意义(P＞0.05)。

　　1.3  治疗方法

    治疗组自胚胎移植后除常规肌注黄体酮外运用中医辨证辅助治疗,予寿胎丸加味以补肾健脾、益气安胎。方药为：菟丝子15 g,桑寄生15 g,续断15 g,阿胶15 g,党参30 g,白术15 g,黄芪30 g,黄芩10 g,鹿角霜10 g,熟地黄10 g,砂仁5 g。腰酸明显者加杜仲10 g；大便秘结可加肉苁蓉10 g；心烦不安、口苦咽干热象明显者去鹿角霜,减党参、黄芪药量,加白芍15 g、生地黄15 g。对照组仅常规肌注黄体酮,不予其他干预。

　　1.4  疗效标准

    胚胎移植后12 d做尿HCG定性检查,阳性者在胚胎移植4周行B超检查,发现孕囊者为临床妊娠,统计2组的临床妊娠率,检测血清平均孕激素(P)、绒毛膜促性腺激素(β-HCG),追踪妊娠结局。

　　1.5  统计学方法

    采用SPSS13.0统计软件进行统计学分析。组间临床妊娠率、流产率用χ2检验,检验水准α＝0.05；组间P、βHCG用x±s表示,比较用t检验,检验水准α＝0.01。

　　2  结果

　　(见表1、表2)表1  2组治疗结果比较（略） 注：与对照组比较,*P＜0.05,**P＜0.01(下同)表2  2组妊娠结局比较（略）