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生殖器结核是输卵管性不孕的重要原因,也是发展中国家寻求体外受精-胚胎移植(IVFET)技术助孕治疗的主要病因。如果结核性不孕患者宫腔形态正常、卵巢功能良好,IVF-ET是治疗结核性不孕的有效方法。生殖器结核可以影响IVF-ET治疗结局,首先表现为能够降低卵巢储备功能。其次,影响胚胎着床,如潜伏性子宫内膜结核由于内膜基底层结核菌的存在,影响内膜下血流及激活抗磷脂抗体,诱发微血栓形成,使胚胎的着床失败;内膜结核可引起内膜粘连、瘢痕化及宫腔形态改变,影响胚胎着床。IVF-ET助孕治疗由于超促排卵,高雌孕激素水平可以激活陈旧结核,使潜伏性结核转为活动性结核。另外,结核患者包括生殖器结核患者妊娠后可以通过多种途径感染胎儿,导致新生儿先天性结核。因此,不孕患者在行辅助生殖技术(ART)助孕治疗前,需考虑筛查结核尤其生殖器结核。对于已确诊的结核感染应当规范地进行抗结核治疗;对于潜伏性结核,给予预防性治疗再行IVF-ET助孕会提高成功率,获得较好的妊娠结局。
Genital tuberculosis is an important cause of tubal infertility and a leading cause of fertility treatment in developing countries seeking IVFT. If tuberculous infertility patients with normal uterine morphology, ovarian function is good, IVF-ET is an effective treatment of tuberculous infertility. Genital tuberculosis can affect IVF-ET treatment outcomes, first manifested as the ability to reduce ovarian reserve. Second, the impact of embryo implantation, such as latent endometrial tuberculosis due to the presence of tuberculoma in the basal layer, affecting the subintimal blood flow and activation of anti-phospholipid antibodies, induced thrombosis, embryo implantation failure; endometrial Tuberculosis can cause endometrial adhesions, scarring and changes in uterine morphology, affecting embryo implantation. IVF-ET assisted treatment due to hyperstimulation, high estrogen and progesterone levels can activate the old tuberculosis, the latent tuberculosis into active tuberculosis. In addition, tuberculosis patients, including genital tuberculosis patients after pregnancy can infect the fetus through a variety of ways, leading to neonatal congenital tuberculosis. Therefore, infertility patients need to consider screening for tuberculosis, especially genital tuberculosis, prior to assisted reproductive technology (ART). For confirmed tuberculosis infection should be standardized for anti-TB treatment; for latent tuberculosis, prophylactic treatment and then IVF-ET assisted pregnancy will increase the success rate, to obtain a better pregnancy outcome.