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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

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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]. 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]. 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.

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