输卵管积水抽液及输卵管结扎对体外受精-胚胎移植临床结局的影响

Effect of hydrosalpinx aspiration and tubal ligation on the clinical outcomes of in vitro fertilization and embryo transfer in the patients with hydrosalpinx associated infertility

目的评价输卵管积水抽液及输卵管结扎对体外受精-胚胎移植(IVF-ET)临床结局的影响。方法回顾性分析2010年8月至2011年8月在四川大学华西第二医院生殖中心因输卵管因素不孕症行IVF-ET治疗的患者资料201例,共237个周期。分为3组,A组:输卵管积水抽液组,共105个周期;B组:输卵管积水近端结扎组,共30个周期。C组:输卵管阻塞且无积水组,共102个周期。结果 3组患者超排天数、促性腺激素(Gn)总量、人绒毛膜促性腺激素(HCG)日内膜厚度、HCG日孕酮(P)水平、移植数、卵裂率、种植率、生化妊娠率、多胎妊娠率、流产率比较,差异均无统计学意义(P>0.05)。A组HCG日雌二醇(E_2)水平、获卵数、获胚数均低于C组,组间差异有统计学意义(P<0.05),B、C组间差异无统计学意义(P>0.05);A组受精率、临床妊娠率小于B组及C组,差异有统计学意义(P<0.05),B、C组间差异无统计学意义(P>0.05)。结论输卵管积水行抽液术并未显著改善输卵管积水引起的低妊娠率,但可以降低流产率;输卵管结扎不影响卵巢功能,并能显著提高妊娠率,降低流产率。

Objective ： To evaluate the effect of hydrosalpinx aspiration and proximal ligation of hydrosalpinx tube on the clinical outcomes of in vitro fertilization and embryo transfer（IVF-ET）in the women with hydrosalpinx. Methods=The data of 237 IVF cycles in 201 women who had the tubal factor infertility and had been treated in this center from August 2010 to August 2011 were retrospectively analyzed. The patients with hydrosalpinx were treated with hydrosalpinx aspiration（group A, 105 cycles）or proximal tubal ligation （group B,30 cycles）,and the patients with obstruction of Fallopian tube but without hydrosalpinx（group C,102 cycles）served as control. The parameters of IVF treatment were collected and compared between different groups. Results： There was no significant difference among 3 groups in the duration of ovary stimulation,the total dose of gonadotropin, the thickness of endometrium on the day of HCG administration, the serum progesterene level on the day of HCG administration,the number of embryos transferred,the implantation rate,the biochemical pregnancy rate, the multiple pregnancy rate, or the miscarriage rate（P〉0.05）. The serum estradiol levels on the day of HCG administration,the number of oocytes retrieved and the number of embryos in group A were significantly lower than those in group C（P〈0.05）, but no significant difference was found between group B and C（P〈0.05）. The fertilization rate and the clinical pregnancy rate in group A were significantly lower than those in group B or group C（P〈0.05） ,while there was no significant difference between group B and C（P〈0.05）. Conclusions： The transvaginal hydrosalpinx aspiration during oocyte collection did not improve the pregnancy rate,but could reduce the miscarriage rate. The proximal tubal ligation seemed to improve the clinical outcomes without compromise of ovarian response to simulation.