探討屢次試管嬰兒著床失敗的原因及其治療

探討屢次試管嬰兒著床失敗的原因及其治療


http://humrep.oxfordjournals.org/cgi/content/abstract/21/12/3036


http://humrep.oxfordjournals.org/cgi/content/full/21/12/3036




Treatment of the embryos
Preimplantation genetic screening
Patients with RIF develop a high percentage of chromosomally abnormal embryos that fail to implant despite regular morphology and developmental rate. Using preimplantation genetic screening (PGS) and selecting chromosomally normal embryos for replacement significantly increased the implantation rates in RIF when 3–8 chromosomes were analysed (Munne, 2003; Pehlivan et al., 2003; Wilding et al., 2004). Taranissi et al. (2005) have shown that PGS for chromosomes 13, 16, 18, 21 and 22 was associated with improved outcome (PR of 43% and delivery rate of 32%) in young women with RIF. However, Caglar et al. (2005) reviewing the literature on PGS in RIF concluded that the data in the literature did not provide firm evidence that patients with RIF will benefit from PGS. They state that PGS can be useful to clarify the reason for recurrent failures.
Wilton et al. (2003) showed that CGH was able to identify many chromosomal abnormalities that would have been missed if those cells had been analysed by FISH. The clinical pregnancy and implantation rates were 11 and 7% for embryos analysed by FISH and 21 and 15% for embryos analysed by CGH. However, CGH remains technically challenging and, in its current form, is likely to be performed in only few laboratories.



Perform your original search, Investigation and treatment of repeated implantation failure following IVF-ET?Human Reproduction?2006, Vol. 21, No. 12. PP. 3036-3043, in Hum. Reprod. Search

Hum. Reprod. Advance Access originally published online on August 12, 2006
Human Reproduction 2006 21(12):3036-3043; doi:10.1093/humrep/del305
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Investigation and treatment of repeatedimplantation failure following IVF-ET

E.J. Margalioth1, A. Ben-Chetrit, M. Gal and T. Eldar-Geva
IVF Unit, Shaare-Zedek Medical Center, Ben Gurion University of the Negev, Jerusalem, Israel
1 To whom correspondence should be addressed at: IVF Unit, Shaare-Zedek Medical Center, PO Box 3235, Jerusalem 91031, Israel. E-mail: ehudmd@hotmail.com
Pregnancy rate following one cycle of IVF and ET can be as high as 60%. But even in the very successful units, some couples fail repeatedly. The causes forrepeated implantation failure (RIF) may be because of reduced endometrial receptivity, embryonic defects or multifactorial causes. Various uterine pathologies, such as thin endometrium, altered expression of adhesive moleculesand immunological factors, may decrease endometrial receptivity, whereas genetic abnormalities of the male or female, sperm defects, embryonic aneuploidy or zona hardening are among the embryonic reasons for failure ofimplantation. Endometriosis and hydrosalpinges may adversely influence both. In this mini review, we discuss the suggested methods for evaluation andtreatment of RIF: repeated hysteroscopy, myomectomy, endometrial stimulation, immunotherapy, preimplantation genetic screening (PGS), assisted hatching, zygote intra-Fallopian transfer (ZIFT), co-culture, blastocyst transfer, cytoplasmic transfer, tailoring stimulation protocols and salpingectomy for hydrosalpinges.

Key words: implantation/IVF failure/IVF treatment/repeated failure

（二）從改善植入的胚胎著手：
（1）胚胎植入前的胚胎切片檢查：著床失敗的胚胎有很大部份是由於胚胎本身染色體異常引起，雖然這些胚胎在植入前外觀及生長速度都正常。如果在植出前取出胚胎中的一個或兩個細胞做檢查，然後只植入正常的胚胎會增加胚胎著床率。但是有的研究指出胚胎植入前切片篩檢並不會增加試管嬰兒助孕的懷