体外受精-胚胎移植后异位妊娠20例临床分析

Clinical analysis on 20 cases with ectopic pregnancy after in vitro fertilization and embryo transfer

目的:探讨体外受精-胚胎移植后异位妊娠的发生率、高危因素及处理方式。方法:回顾性分析2009年2月～2011年2月接受IVF/ICSI治疗后发生异位妊娠的患者20例,并随机选取IVF/ICSI治疗后正常宫内妊娠100例作为正常对照。结果:IVF/ICSI共治疗1 434个周期,临床妊娠645例,临床妊娠率为44.98%(645/1 434),其中发生异位妊娠20例,发生率为3.10%(20/645),其中宫内外同时妊娠2例,输卵管间质部妊娠2例,宫角妊娠1例。20例异位妊娠的不孕原因中,有16例为输卵管因素,3例为多囊卵巢综合征,3例有子宫内膜息肉,4例为子宫内膜异位症,8例有既往异位妊娠史,7例有流产史。两组患者的年龄、不孕年限、不孕类型、体重指数(BMI)、助孕方式、移植胚胎类型、人绒毛膜促性腺激素注射日雌二醇及黄体生成素水平、子宫内膜厚度等比较差异均无统计学意义(P>0.05),而人绒毛膜促性腺激素注射日孕激素水平、雌二醇/孕激素比值的差异有统计学意义(P<0.05)。结论:输卵管病变和盆腔炎是辅助生殖术后异位妊娠发生的高危因素,阴道超声检查结合血β-HCG值测定是最有效的诊断措施,腹腔镜下输卵管切除术是目前治疗异位妊娠的较好方法。

Objective： To explore the incidence rate, high risk factors, and treatment of ectopic pregnancy after in vitro fertiliza- tion and embryo transfer （IVF- ET） . Methods： Twenty patients with eetopie pregnancy after IVF/intracytoplasmie sperm injection （IC- SI） from February 2009 to February 2011 were analyzed retrospectively, and 100 women with normal intrauterine pregnancy after IVF/ICSI were randomly selected as control group. Results： There were 1 434 IVF/ICSI cycles totally, 645 cases got clinical pregnancy, the clinical pregnancy rate was 44. 98% （645/1 434）, 20 cases got ectopie pregnancy, the incidence rate was 3.10% （20/645）, 2 cases got intrauter- ine pregnancy and eetopie pregnancy simultaneously, 2 cases got interstitial tubal pregnancy, and one case got angular pregnancy. Among 20 cases with ectopie pregnancy, 16 cases were found with tubal factors, 3 cases were found with polycystie ovary syndrome （PCOS）, 3 cases were found with endometrial polyp, 4 cases were found with endometriosis, 8 cases had history of ectopic pregnancy, and 7 cases had history of abortion. There was no statistically significant difference in age, duration of infertility, infertile types, body mass index （BMI）, patterns of assisted reproduction, ET types, estradiol and luteinizing hormone levels on the day of human chorionie gonadotropin （HCG） injection, and depth of endometrium between the two groups （ P 〉 O. 05 ）, but there were statistically significant differences in progestogen level on the day of HCG injection and ratio of estradiol/progestogen between the two groups （P 〈0. 05 ） . Conclusion： Tubal lesions and pelvic inflam- mation are high risk factors of eetopic pregnancy after assisted reproduction, vaginal ultrasonography combined with blood β - HCG detection is the most effective diagnostic measure, laparoscopic salpingectomy is a good method to treat eetopic pregnancy at present.