反复胚胎种植失败的临证认知与策略

唐诗 尤昭玲 邢艺璇 游卉 莫蕙

〔摘要〕 胚胎移植是辅助生殖流程中的关键环节。反复胚胎种植失败，给原本就面临生育困难的家庭带来沉重的负担。中医药精准介入是提高着床率、生育率的重要举措。全国名中医尤昭玲认为，胚胎移植周期前，采用经阴道三维彩超进行子宫内膜容受性评估，能精准调膜疗疾。围着床期，提出“安营扎寨”理论，以脾肾主辅论治，即移植期脾主肾辅，创制尤氏着床方、着床煲；着床后肾主脾辅，创制尤氏养胎方、养胎煲，以实现中医药精准调治，达到改善子宫内膜容受性、促进胚胎着床、促进生育的目标。

〔关键词〕 反复种植失败；胚胎移植；不孕症；中医药；安胎二步法；子宫内膜容受性

〔中图分类号〕R271.4       〔文献标志码〕A        〔文章编号〕doi：10.3969/j.issn.1674－070X.２０23.04.011

Clinical cognition and strategies for recurrent implantation failure： Academic thought and

clinical experience of the national famous TCM practitioner YOU Zhaoling

TANG Shi1，2， YOU Zhaoling1*， XING Yixuan1，2， YOU Hui1， MO Hui2

1. The First Hospital of Hunan University of Chinese Medicine， Changsha， Hunan 410007， China;

2. Macau University of Science and Technology， Macau 999078， China

〔Ａｂｓｔｒａｃｔ〕 Embryo transfer is a key step to the assisted reproduction， while recurrent implantation failure（RIF） has brought heavy burden to infertile families. Chinese medicine can increase the implantation and fertility rate for RIF patients. The national famous TCM practitioner YOU Zhaoling believes that， before embryo transfer， the endometrium can be accurately adjusted by assessing the endometrial receptivity with transvaginal three-dimensional color ultrasound. Then， as to the peri-implantation period， she proposes the "settling down and then camping" theory that the spleen plays the key role while the kidney assists， and patients are prescribed You's Implantation Decoction and You's Implantation pot. After implantation， the kidney plays the key role while the spleen assists， and patients are prescribed You's Nurturing Fetus Decoction and You's Nurturing Fetus Pot. To sum up， Chinese medicine can precisely regulate and treat RIF patients， improve endometrial receptivity， thus enabling the implantation and increasing fertility.

〔Ｋｅｙｗｏｒｄｓ〕 recurrent implantation failure; embryo transfer; infertility; Chinese medicine; two-step strategy for tranquili？鄄

zing fetus to prevent miscarriage; endometrial receptivity

國家统计局发布数据显示，2022年我国已出现人口负增长，低生育率成为影响我国人口均衡发展的最重要风险[1]，“怀不上、保不住、生不好”问题已成为实现“健康中国2030”[2]的重大阻碍，优化生育政策、解决生殖健康困境、提高生育率刻不容缓。人类体外受精-胚胎移植（in vitro fertilization-embryo transfer， IVF-ET）历经50余年发展，帮助众多不孕不育家庭实现生育目标。

在IVF-ET中，单个胚胎移植成功率为40%，而反复种植失败（recurrent implantation failure， RIF）全球发病率约10%[3]。RIF的定义尚未达成共识，《反复种植失败临床诊治中国专家共识》中建议将RIF定义为：40岁以下成年女性，在3个新鲜或冷冻周期内移植3枚优质胚胎后，仍未能实现临床妊娠[3]。RIF的发生与高龄、体质量指数升高、卵巢功能低下、胚胎非整倍体、子宫内膜容受性（endometrial receptivity， ER）低下以及部分免疫因素等密切相关。……