ارزيابي علل موثر بر شكست مكرر لانه گزيني جنين در درمانهاي كمك باروري

Assessment of effective factors in recurrent implantation failure (RIF) following assisted reproductive technology (ART

ﻋﻠﯽ رﻏﻢ ﭘﯿﺸﺮﻓﺘﻬﺎي ﻓﺮاوان در زﻣﯿﻨﻪ روﺷﻬﺎي ﮐﻤﮏ ﺑﺎروري، اﻣـﺎ ﻫﻨـﻮز ﻣﯿﺰان ﻻﻧﻪ ﮔﺰﯾﻨﯽ ﭘـﺲ از اﻧﺘﻘـﺎل ﺟﻨـﯿﻦ اﻓـﺰاﯾﺶ ﭼﺸﻤﮕﯿﺮي ﻧﺪاﺷﺘﻪ اﺳﺖ. ﻟﺬا اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺑﻪ ﻣﻨﻈﻮر ﺑﺮرﺳﯽ ﺑﺮﺧﯽ ﻋﻮاﻣﻞ اﺣﺘﻤﺎﻟﯽ ﻣﻮﺛﺮ ﺑﺮ ﺷﮑﺴﺖ ﻣﮑﺮر ﻻﻧﻪﮔﺰﯾﻨﯽ ﺟﻨﯿﻦ )Recurrent Implantation Failure( در درﻣﺎﻧﻬﺎي ﮐﻤﮏ ﻧﺎﺑﺎروري اﻧﺠﺎم ﺷﺪ. ﻣﻮاد و روش ﻫﺎ: اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﮔﺬﺷﺘﻪ ﻧﮕﺮ ﺑﺮ روي 80 ﺑﯿﻤﺎر ﻧﺎﺑﺎرور ﺑﺎ ﺣﺪاﻗﻞ ﺳﺎﺑﻘﻪ 3 ﺑﺎر ﺷﮑﺴﺖ در ﻻﻧﻪ ﮔﺰﯾﻨﯽ ﺟﻨﯿﻦ)RIF( ﭘﺲ از درﻣﺎﻧﻬﺎي ﮐﻤﮏ ﻧﺎﺑﺎروري، ﻣﺮاﺟﻌﻪ ﮐﻨﻨﺪه ﺑﻪ ﻣﺮﮐﺰ ﻧﺎﺑﺎروري ﻓﺎﻃﻤﻪ اﻟﺰﻫﺮا )س( ﺑﺎﺑﻞ ﻃﯽ ﺳﺎﻟﻬﺎي 1392-96 اﻧﺠﺎم ﺷﺪ. 80 ﻧﻔﺮ از ﺧﺎﻧﻤﻬﺎﯾﯽ ﮐﻪ ﺑﺎ اﻧﺠﺎم ﯾﮏ ﻧﻮﺑﺖ اﻧﺘﻘﺎل ﺟﻨﯿﻦ در IVF ﺑﺎردار ﺷﺪﻧﺪ ﻧﯿﺰ ﺑﻌﻨﻮان ﮔﺮوه ﺷﺎﻫﺪ در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪﻧﺪ. ﻣﺘﻐﯿﺮﻫﺎي ﻣﺮﺑﻮط ﺑﻪ ﻧﺎﺑﺎروري، اﺧﺘﻼﻻت اﻧﺪوﮐﺮﯾﻦ و آﻧﺪوﻣﺘﺮﯾﻮز ﺛﺒﺖ و اﺛﺮ آن ﺑﺮ ﺷﮑﺴﺖ ﻣﮑﺮر ﻻﻧﻪﮔﺰﯾﻨﯽ ﺟﻨﯿﻦ در دو ﮔﺮوه ﻣﻘﺎﯾﺴﻪ ﺷﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: ﻣﯿﺎﻧﮕﯿﻦ BMI ﺑﯿﻤﺎران ﮔﺮوه ﻣﻮرد 26/39±3/63 و ﮔﺮوه ﺷﺎﻫﺪ 26/77±4/49 ﺑﻮده اﺳﺖ. ﺷﺎﺧﺺ ﺗﻮده ﺑﺪﻧﯽ )BMI( ﺑﺎﻻﺗﺮ از 30 ﺑﻄﻮر ﻣﻌﻨﯽ داري ﻣﻮﺟﺐ اﻓﺰاﯾﺶ ﺧﻄﺮ ﺷﮑﺴﺖ ﻣﮑﺮر ﻻﻧﻪ ﮔﺰﯾﻨﯽ ﺟﻨﯿﻦ ﺷﺪه اﺳﺖ )0/001=p(. ﺑﻌﺪ از ﺗﻌﺪﯾﻞ اﺛﺮ ﺳﺎﯾﺮ ﻋﻮاﻣﻞ ﻣﺪاﺧﻠﻪ ﮐﻨﻨﺪه اﺣﺘﻤﺎﻟﯽ، اﺣﺘﻤﺎل ﺧﻄﺮ)Odds ratios( ﭼﺎﻗﯽ ﺑﺮ ﻋﺪم ﻻﻧﻪ ﮔﺰﯾﻨﯽ ﻣﮑﺮر ﺑﺎ 95-CI، )0/91-1/19( 1/09 ﻣﺤﺎﺳﺒﻪ ﺷﺪ، ﮐﻪ ﻣﻌﻨﯽ دار ﻧﺒﻮده اﺳﺖ )p=0/06(. ﺑﯿﻦ ﻣﺘﻐﯿﺮﻫﺎي ﻋﻠﺖ و ﻧﻮع ﻧﺎﺑﺎروري، اﺧﺘﻼﻻت اﻧﺪوﮐﺮﯾﻦ، ﻧﺎﻫﻨﺠﺎريﻫﺎي رﺣﻤﯽ، آﻧﺪوﻣﺘﺮﯾﻮز، ﺗﺨﻤﺪان ﭘﻠﯽ ﮐﯿﺴﺘﯿﮏ و ﻋﺎﻣﻞ ﺷﮑﺴﺖ ﻣﮑﺮر ﻻﻧﻪ ﮔﺰﯾﻨﯽ ﺟﻨﯿﻦ در دو ﮔﺮوه ﻣﻮرد و ﺷﺎﻫﺪ ﺗﻔﺎوت ﻣﻌﻨﯽ داري وﺟﻮد ﻧﺪاﺷﺖ. ﻧﺘﯿﺠﻪ ﮔﯿﺮي: ﻧﺘﺎﯾﺞ اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎن داد ﮐﻪ BMI، ﻧﻮع و ﻋﻠﺖ ﻧﺎﺑﺎروري، اﺧﺘﻼﻻت اﻧﺪوﮐﺮﯾﻦ، ﻧﺎﻫﻨﺠﺎريﻫﺎي رﺣﻤﯽ، آﻧﺪوﻣﺘﺮﯾﻮز، ﺗﺨﻤﺪان ﭘﻠﯽ ﮐﯿﺴﺘﯿﮏ ﺑﺮ ﺷﮑﺴﺖ ﻣﮑﺮر ﻻﻧﻪﮔﺰﯾﻨﯽ ﺟﻨﯿﻦ ﻣﻮﺛﺮ ﻧﺒﻮده اﻧﺪ.

Despite many advances have been made in the assisted reproduction techniques (ART), implantation rate after embryo transfer has not increased significantly. This study aims to determine the factors involved in recurrent implantation failure (RIF) following ART. Methods In this retrospective study, 80 infertile patients with a history of at least 3 recurrent implantation failure (RIF) following assisted reproductive technology (ART) were referred to Fatemezahra Infertility Center in Babol from March 2006 to March 2013 were selected. The control group also included 80 women who became pregnant following the first IVF. Associated factors of infertility, endocrine disorder and endometriosis were recorded and their effect on RIF was assessed in both groups. P-value<0.05 was considered significant. Results The mean BMI was 26.39±3.63 in the case group and 26.77±4.49 in the control group. Body mass index (BMI) >30 increased the risk of RIF significantly (P = 0.001). After adjusting for the effects of other possible confounding factors, the odds ratio of obesity on RIF was 1.09 (0.91-1.19) 95% CI which was not significant (P = 0.06). There were no significant differences among type and cause of infertility, endocrine abnormalities, uterine malformations, endometriosis and polycystic ovary with RIF. Conclusion According to our findings, BMI, type and cause of infertility, endocrine disorders, uterine abnormalities, endometriosis, and polycystic ovary were not effective on recurrent implantation failure. Future studies by eliminating the effect of more confounders may clarify our findings.