Assisted Reproductive Technology Results and Microorganism Contamination

細菌感染和人工生殖結果的相關性研究

黃瑞琮(Jui-Tsung Huang) ； 蔡欣潔(Hsin-Chieh Tsai) ； 沙立(Li Sha) ； 林錫宏(His-Hung Lin) ； 蔡文高(Wen-Gau Tsai) ； 吳東壁(Tung-Pi Wu) ； 羅丹梓(Tan-Tzu Lo)

《南臺灣醫學雜誌》 5卷1期 (2009/04) Pp. 1-6

https://doi.org/10.6726/MJST.200904_5(1).0001

摘要

目的：子宮頸是女性生殖道阻隔細菌的天然屏障。正常情況下陰道內的細菌並不會上行感染到子宮腔和腹腔，但是在執行人工生殖時，必須使用導管，將配子或胚胎直接植入子宮腔，相對的也提高了子宮內感染的機會。本研究主要目的是研究感染和人工生殖結果的相關性、常見的病源菌，及可能的預防或補救措施。方法：以新樓院人工生殖個案為研究對象。施行人工生殖植入配子（IUI）或胚胎（ET）時，個案依標準人工生殖操作，在撤出植入管時，避免植入管頂端接觸陰道璧及器械避免污染，然後以無菌剪刀剪下植入管頂端放入培養液，送細菌室作培養檢驗。結果：IUI組細菌培養陽性率為79%，IVF組陽性率則為65%。IUI組懷孕率為14.5%，IVF組懷孕率則為35%。成功懷孕的病人中，IUI組細菌培養陽性率為85.7%（p=0.54），IVF組細菌培養陽性率為71%（p=0.021）。IUI組流產率為14%。結論：IVF組細菌培養陽性和懷孕率有意義，但是在臨床上植入管細菌培養為陽性並不能代表子宮內的感染。我們數據顯示細菌和懷孕率及流產率沒有直接相關的關聯。但是細菌培養陽性率高，植入前應適當的消毒以減低細菌污染的機率。

關鍵字

細菌培養 ； 人工受精 ； 試管嬰兒

並列摘要

Objective: The uterine cervix plays an important role of gatekeeper, therefore microorganism presents in vagina seldom infects the uterine cavity in normal condition. While in Assisted Reproductive Technology (ART) procedures, we use transfer tube to put the gametes and zygotes through cervix into uterine cavity. These procedures carry a risk of uterine infection and may lead to a tragic pregnancy result. The purpose of this study is to explore the rate of contamination while put transfer tube into uterine cavity, and the impact of contamination on pregnancy rate.Methods: We did the bacteria workup for the ART cases, including embryo transfer (ET) and intrauterine insemination (IUI), at Sin-Lau hospital from January 2006 to July 2006. Before transfer procedure, the cervix was copiously irrigated with warmed normal saline. During and after the transfer procedure, the transfer tip was kept away from touching vagina wall. The transfer tip was cut and collected with sterile scissor and send to the microorganism laboratory immediately. We also perform the PCR test for detection of C. trachomatis and N. gonorrhoeae.Results: In our data, none of our cases was positive for C. trachomatis and N. gonorrhoeae. In the IUI and IVF-ET cases, the bacteria culture positive rate was 79 % (38/48) and 65% (13/20) respectively. The pregnancy rate was 14.5% (7/48) in IUI group and 35% (7120) in IVF group. The abortion rate was 14% (1/7) in IUI group and 0% in IVF group. In the pregnancy cases of IUI and IVF-E T, the bacteria culture positive rate was 85% (6/7) (p=0.54) and 71% (5/7) (p=0.02l) respectively. There is no statistic difference between contamination and non-contamination group in the pregnancy rate. But in IVF cases, the contamination group has higher pregnancy rate than non-contamination group in IUI group. Most of the cultured bacteria were normal vagina bacteria flora such as coagulase negative staphylococcus (non-staphylococcus saprophyticas), gram (+) Bacillus, etc. In rare condition, we found some infection bacterial like Group B streptococcus (9.3 %) and Candia albicans (3%). One abortion case pregnant by IUI has contaminated by candida albicans.Conclusions: Although we find high positive culture rate on transfer tip in our ART cases. But it did not decrease our pregnancy outcome or increase abortion rate. The high positive culture rate alarms us to clean the cervix more thoroughly to decrease contamination.

並列關鍵字

in vitro fertilization ； intrauterine insemination ； bacteria culture