切换至 "中华医学电子期刊资源库"

中华产科急救电子杂志 ›› 2019, Vol. 08 ›› Issue (03) : 155 -160. doi: 10.3877/cma.j.issn.2095-3259.2019.03.007

所属专题: 文献

专家论坛

反复胚胎种植失败的原因和处理
倪天翔1, 颜军昊1,()   
  1. 1. 250021 济南,山东大学附属生殖医院生殖遗传科
  • 收稿日期:2019-04-03 出版日期:2019-08-18
  • 通信作者: 颜军昊

Causes and treatment of repeated embryo implantation failure

Tianxiang Ni1, Junhao Yan1()   

  • Received:2019-04-03 Published:2019-08-18
  • Corresponding author: Junhao Yan
引用本文:

倪天翔, 颜军昊. 反复胚胎种植失败的原因和处理[J/OL]. 中华产科急救电子杂志, 2019, 08(03): 155-160.

Tianxiang Ni, Junhao Yan. Causes and treatment of repeated embryo implantation failure[J/OL]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2019, 08(03): 155-160.

反复胚胎种植失败(recurrent implantation failure,RIF)病因复杂,包括胚胎因素、子宫因素以及免疫因素等,均可影响胚胎种植潜能、内膜容受性以及两者发育的同步性导致种植失败。RIF的诊疗应结合病因及既往治疗过程。目前提倡全胚冷冻和囊胚移植,胚胎可通过植入前遗传学检测及其他指标进行筛选,并根据内膜容受性检测结果尝试个性化移植。生殖系统解剖结构异常应及时给予手术和药物治疗,其中子宫内膜薄仍是目前治疗的难题。其中,内膜微刺激是治疗RIF的重要手段,但仍需更充分的证据得以支持。经验性治疗(免疫治疗、阿司匹林、肝素等)应在循证医学的基础上谨慎应用,并应注重患者生活方式的调整和心理干预。

The causes of recurrent implantation failure (RIF) contain embryo factors, uterine factors and immunological factors which can impair embryo development and implantation potentials, endometrial receptivity and the embryo-endometrium synchrony, leading to implantation failure. The management of RIF should be based on thorough review of the underlying causes and the previous treatment. To date, "freeze-all" policy and blastocyst transfer are advocated, preimplantation genetic testing and biomarkers are applied for screening embryos. Personalized embryo transfer can be implemented by combining endometrial receptivity state. Anatomic abnormalities of reproductive system are advised to be treated with surgical and medical therapy, but thin endometrium is still considered as a difficult problem. Besides, endometrial scratch is an important method for RIF treatment, but further evidence is required to support it. Empirical therapies, such as immunotherapy, aspirin and heparin, should be seriously considered and offered on basis of evidence. Furthermore, great attention should be given to lifestyle adjustments and psychological interventions for RIF patients.

[1]
Simon A, Laufer N. Repeated implantation failure: clinical approach [J]. Fertil Steril, 2012, 97(5): 1039-1043.
[2]
Thornhill AR, deDie-Smulders CE, Geraedts JP, et al. ESHRE PGD Consortium 'Best practice guidelines for clinical preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS)’ [J]. Hum Reprod, 2005, 20(1): 35-48.
[3]
Coughlan C, Ledger W, Wang Q, et al. Recurrent implantation failure: definition and management [J]. Reprod Biomed Online, 2014, 28(1): 14-38.
[4]
《胚胎植入前遗传学诊断/筛查专家共识》编写组. 胚胎植入前遗传学诊断/筛查技术专家共识 [J]. 中华医学遗传学杂志,2018, 35(2): 151-155.
[5]
Bender Atik R, Christiansen OB, Elson J, et al. ESHRE guideline: recurrent pregnancy loss [J]. Hum Reprod Open, 2018, 2018(2): hoy004.
[6]
Munne S. Status of preimplantation genetic testing and embryo selection [J]. Reprod Biomed Online, 2018, 37(4): 393-396.
[7]
Shapiro BS, Daneshmand ST, Desai J, et al. The risk of embryo-endometrium asynchrony increases with maternal age after ovarian stimulation and IVF [J]. Reprod Biomed Online, 2016, 33(1): 50-55.
[8]
Franasiak JM, Forman EJ, Hong KH, et al. The nature of aneuploidy with increasing age of the female partner: a review of 15,169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening [J]. Fertil Steril, 2014, 101(3): 656-663.
[9]
Assou S, Haouzi D, De Vos J, et al. Human cumulus cells as biomarkers for embryo and pregnancy outcomes [J]. Mol Hum Reprod, 2010, 16(8): 531-538.
[10]
Absalan F, Ghannadi A, Kazerooni M, et al. Value of sperm chromatin dispersion test in couples with unexplained recurrent abortion [J]. J Assist Reprod Genet, 2012, 29(1): 11-14.
[11]
Gat I, Li N, Yasovich N, et al. Sperm DNA fragmentation index does not correlate with blastocyst euploidy rate in egg donor cycles [J]. Gynecol Endocrinol, 2018, 34(3): 212-216.
[12]
Jin J, Pan C, Fei Q, et al. Effect of sperm DNA fragmentation on the clinical outcomes for in vitro fertilization and intracytoplasmic sperm injection in women with different ovarian reserves [J]. Fertil Steril, 2015, 103(4): 910-916.
[13]
Coughlan C, Clarke H, Cutting R, et al. Sperm DNA fragmentation, recurrent implantation failure and recurrent miscarriage [J]. Asian J Androl, 2015, 17(4): 681-685.
[14]
Raziel A, Friedler S, Schachter M, et al. Increased frequency of female partner chromosomal abnormalities in patients with high-order implantation failure after in vitro fertilization [J]. Fertil Steril, 2002, 78(3): 515-519.
[15]
Ban-Frangez H, Tomazevic T, Virant-Klun I, et al. The outcome of singleton pregnancies after IVF/ICSI in women before and after hysteroscopic resection of a uterine septum compared to normal controls [J]. Eur J Obstet Gynecol Reprod Biol, 2009, 146(2): 184-187.
[16]
Zepiridis LI, Grimbizis GF, Tarlatzis BC. Infertility and uterine fibroids [J]. Best Pract Res Clin Obstet Gynaecol, 2016, 34: 66-73.
[17]
Bosteels J, Weyers S, Puttemans P, et al. The effectiveness of hysteroscopy in improving pregnancy rates in subfertile women without other gynaecological symptoms: a systematic review [J]. Hum Reprod Update, 2010, 16(1): 1-11.
[18]
Zhang H, He X, Tian W, et al. Hysteroscopic Resection of Endometrial Polyps and Assisted Reproductive Technology Pregnancy Outcomes Compared with No Treatment: A Systematic Review [J]. J Minim Invasive Gynecol, 2018.
[19]
Dawood A, Al-Talib A, Tulandi T. Predisposing factors and treatment outcome of different stages of intrauterine adhesions [J]. J Obstet Gynaecol Can, 2010, 32(8): 767-770.
[20]
Miwa I, Tamura H, Takasaki A, et al. Pathophysiologic features of " thin" endometrium [J]. Fertil Steril, 2009, 91(4): 998-1004.
[21]
Liu KE, Hartman M, Hartman A, et al. The impact of a thin endometrial lining on fresh and frozen-thaw IVF outcomes: an analysis of over 40 000 embryo transfers [J]. Hum Reprod, 2018, 33(10): 1883-1888.
[22]
Richter KS, Bugge KR, Bromer JG, et al. Relationship between endometrial thickness and embryo implantation, based on 1,294 cycles of in vitro fertilization with transfer of two blastocyst-stage embryos [J]. Fertil Steril, 2007, 87(1): 53-59.
[23]
Moreno I, Cicinelli E, Garcia-Grau I, et al. The diagnosis of chronic endometritis in infertile asymptomatic women: a comparative study of histology, microbial cultures, hysteroscopy, and molecular microbiology [J]. Am J Obstet Gynecol, 2018, 218(6): 602 e601-602 e616.
[24]
Cicinelli E, Matteo M, Tinelli R, et al. Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy [J]. Hum Reprod, 2015, 30(2): 323-330.
[25]
Strandell A, Lindhard A, Waldenstrom U, et al. Hydrosalpinx and IVF outcome: a prospective, randomized multicentre trial in Scandinavia on salpingectomy prior to IVF [J]. Hum Reprod, 1999, 14(11): 2762-2769.
[26]
Blois SM, Klapp BF, Barrientos G. Decidualization and angiogenesis in early pregnancy: unravelling the functions of DC and NK cells [J]. J Reprod Immunol, 2011, 88(2): 86-92.
[27]
The role of immunotherapy in in vitro fertilization: a guideline [J]. Fertil Steril, 2018, 110(3): 387-400.
[28]
Anblagan D, Jones NW, Costigan C, et al. Maternal smoking during pregnancy and fetal organ growth: a magnetic resonance imaging study [J]. PLoS One, 2013, 8(7): e67223.
[29]
Pasch LA, Gregorich SE, Katz PK, et al. Psychological distress and in vitro fertilization outcome [J]. Fertil Steril, 2012, 98(2): 459-464.
[30]
Sebastian-Leon P, Garrido N, Remohi J, et al. Asynchronous and pathological windows of implantation: two causes of recurrent implantation failure [J]. Hum Reprod, 2018, 33(4): 626-635.
[31]
Shapiro BS, Daneshmand ST, Garner FC, et al. Clinical rationale for cryopreservation of entire embryo cohorts in lieu of fresh transfer [J]. Fertil Steril, 2014, 102(1): 3-9.
[32]
Hatirnaz S, Ozer A, Hatirnaz E, et al. Pre-implantation genetic screening among women experiencing recurrent failure of in vitro fertilization [J]. Int J Gynaecol Obstet, 2017, 137(3): 314-318.
[33]
The use of preimplantation genetic testing for aneuploidy (PGT-A): a committee opinion [J]. Fertil Steril, 2018, 109(3): 429-436.
[34]
Fragouli E, Spath K, Alfarawati S, et al. Altered levels of mitochondrial DNA are associated with female age, aneuploidy, and provide an independent measure of embryonic implantation potential [J]. PLoS Genet, 2015, 11(6): e1005241.
[35]
Rodgaard T, Heegaard PM, Callesen H. Non-invasive assessment of in-vitro embryo quality to improve transfer success [J]. Reprod Biomed Online, 2015, 31(5): 585-592.
[36]
Goto S, Takebayashi K, Shiotani M, et al. Effectiveness of 2-step (consecutive) embryo transfer. Comparison with cleavage-stage transfer [J]. J Reprod Med, 2003, 48(5): 370-374.
[37]
Wu Q, Li H, Zhu Y, et al. Dosage of exogenous gonadotropins is not associated with blastocyst aneuploidy or live-birth rates in PGS cycles in Chinese women [J]. Hum Reprod, 2018, 33(10): 1875-1882.
[38]
Orvieto R, Brengauz M, Feldman B. A novel approach to normal responder patient with repeated implantation failures--a case report [J]. Gynecol Endocrinol, 2015, 31(6): 435-437.
[39]
Saccone G, Schoen C, Franasiak JM, et al. Supplementation with progestogens in the first trimester of pregnancy to prevent miscarriage in women with unexplained recurrent miscarriage: a systematic review and meta-analysis of randomized, controlled trials [J]. Fertil Steril, 2017, 107(2): 430-438 e433.
[40]
Shalom-Paz E, Anabusi S, Michaeli M, et al. Can intra cytoplasmatic morphologically selected sperm injection (IMSI) technique improve outcome in patients with repeated IVF-ICSI failure? a comparative study [J]. Gynecol Endocrinol, 2015, 31(3): 247-251.
[41]
Teixeira DM, Barbosa MA, Ferriani RA, et al. Regular (ICSI) versus ultra-high magnification (IMSI) sperm selection for assisted reproduction [J]. Cochrane Database Syst Rev, 2013(7): CD010167.
[42]
Tremellen K, Russell P. Adenomyosis is a potential cause of recurrent implantation failure during IVF treatment [J]. Aust N Z J Obstet Gynaecol, 2011, 51(3): 280-283.
[43]
Gao L, Huang Z, Lin H, et al. Bone Marrow Mesenchymal Stem Cells (BMSCs) Restore Functional Endometrium in the Rat Model for Severe Asherman Syndrome [J]. Reprod Sci, 2019, 26(3): 436-444.
[44]
Ruiz-Alonso M, Blesa D, Diaz-Gimeno P, et al. The endometrial receptivity array for diagnosis and personalized embryo transfer as a treatment for patients with repeated implantation failure [J]. Fertil Steril, 2013, 100(3): 818-824.
[45]
Barash A, Dekel N, Fieldust S, et al. Local injury to the endometrium doubles the incidence of successful pregnancies in patients undergoing in vitro fertilization [J]. Fertil Steril, 2003, 79(6): 1317-1322.
[46]
Sar-Shalom Nahshon C, Sagi-Dain L, Wiener-Megnazi Z, et al. The impact of intentional endometrial injury on reproductive outcomes: a systematic review and meta-analysis [J]. Hum Reprod Update, 2019, 25(1): 95-113.
[47]
Dreyer K, Lier MC, Emanuel MH, et al. Hysteroscopic proximal tubal occlusion versus laparoscopic salpingectomy as a treatment for hydrosalpinges prior to IVF or ICSI: an RCT [J]. Hum Reprod, 2016, 31(9): 2005-2016.
[1] 王聪, 李云涛, 唐甜甜, 王鑫蕊, 吕鑫, 范志刚. 多基因检测对激素受体阳性、HER-2阴性乳腺癌新辅助化疗疗效预测的研究进展[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(05): 292-296.
[2] 葛睿, 陈飞, 李杰, 李娟娟, 陈涵. 多基因检测在早期乳腺癌辅助治疗中的应用价值[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(05): 257-263.
[3] . 美国临床肿瘤学会关于乳腺癌胚系基因检测的相关建议[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(04): 255-255.
[4] 王敏, 周玲. 复发性流产的遗传因素病因学研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 374-381.
[5] 王莉, 曹蕾, 王亚丹, 张伟. Krabbe病1例临床分析并文献复习[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 339-345.
[6] 高青卓, 康宜凡, 王治鸿. 体外受精周期中单原核胚胎的临床研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 260-265.
[7] 林昌盛, 战军, 肖雪. 上皮性卵巢癌患者诊疗中基因检测及分子靶向药物治疗[J/OL]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 505-510.
[8] 樊丽超, 郭瑾瑛, 陈鑫. 野生型RET与RET/PTC融合基因检测对甲状腺乳头状癌中央区淋巴结清扫的指导意义[J/OL]. 中华普外科手术学杂志(电子版), 2023, 17(06): 631-635.
[9] 洪凡, 陈敦金, 傅洋, 梁新月, 吴毅, 王晓怡. 体外受精-胚胎移植妊娠合并前置胎盘临床研究[J/OL]. 中华产科急救电子杂志, 2024, 13(03): 176-182.
[10] 粟睿, 周璇, 杨殊琳, 方晨韵, 陈素华, 邓东锐, 曾万江, 刘海意, 龚洵, 吴媛媛, 刘燕燕, 肖娟, 余俊, 何梦舟, 李淑芳, 王子琢, 林星光, 乌剑利, 王少帅, 岳静, 靳镭, 冯玲, 丁文成. 经辅助生殖技术妊娠患者早产的影响因素分析[J/OL]. 中华产科急救电子杂志, 2024, 13(03): 168-175.
[11] 李任远, 梁桂宁, 于馨洋, 张莹. 基因检测及胚胎植入前单基因遗传学检测在优生优育中的作用[J/OL]. 中华产科急救电子杂志, 2024, 13(02): 117-120.
[12] 胡采宏, 张卫社. 辅助生殖技术与早期流产[J/OL]. 中华产科急救电子杂志, 2024, 13(02): 69-72.
[13] 卫星, 孙路明. 辅助生殖技术与胎儿生长障碍[J/OL]. 中华产科急救电子杂志, 2024, 13(02): 88-92.
[14] 张成惠, 闫中瑞, 盛志强, 袁嫣然. 脑肌酸缺乏症诊断与治疗研究进展[J/OL]. 中华诊断学电子杂志, 2024, 12(04): 270-275.
[15] 赵超, 史帝, 王暖, 陈国芳. 肯尼迪病合并血清抗体阴性重症肌无力一例[J/OL]. 中华诊断学电子杂志, 2024, 12(04): 236-240.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?