体外受精-胚胎移植后异位妊娠86例临床分析

Analysis of 86 ectopic pregnancy cases after in vitro fertilization and embryo transfer

目的探讨辅助生殖技术中异位妊娠(EP)的发生率、影响因素和早期诊疗、防治的方法。方法回顾性分析体外受精-胚胎移植(IVF-ET)、卵胞浆内单精子显微注射(ICSI)、胚胎植入前遗传学诊断(PGD)和冻融胚胎移植(FET)治疗后86例EP患者的临床资料。结果共有2 903个周期获临床妊娠,86例EP,发生率2.96%,其中包括宫内宫外同时妊娠4例(4.65%)。患者年龄、不孕年限、体重指数、是否合并排卵障碍、男方因素不孕、染色体异常、既往分娩史、获卵数、移植胚胎数目、移植管进入宫腔深度对EP的发生影响不大。输卵管盆腔病变、子宫内膜异位症及其术后与EP的发生有显著的关联(OR=11.457,P=0.000;OR=3.479,P=0.002)。子宫内膜厚度≥7.5 mm时,输卵管妊娠风险则有所下降(OR=10.463,P=0.002)。结论输卵管盆腔病变,子宫内膜异位症及其术后,移植日子宫内膜厚度是EP发生的重要影响因素。妊娠早期血人绒毛膜促性腺激素(HCG)监测结合阴道B超检查是EP主要的早期诊断方法。

Objective To investigate the incidence, affecting factors, early diagnosis, prevention and treatment methods of ectopic pregnancy（ EP） in assisted reproductive technology. Methods A retrospective review was done on the clinical data of 86 patients with EP after in vitro fertilization and embryo transfer（ IVF-ET） , intracytoplasmic sperm injection（ ICSI） , preimplantation genetic diagnosis（ PGD） and frozen-thawing embryo transfer（ F-ET） . Re-sults A total of 2 903 clinical pregnancies were obtained, and 86 ectopic pregnancies, the rate of EP was 2. 96%, of which 4 cases were heterotopic pregnancy（4. 65%） . It appeared to be no relationship in these aspects, that was, age, duration of infertility, body mass index（BMI）, ovulation dysfunction, infertility caused by male, chromosome abnormality, history of childbirth, the average follicle numbers, the average graftage embryonic num-ber and the depth of transplant tube into the uterine cavity. However, tubal and pelvic diseases, endometriosis or endometriosis postoperatively was significantly associated with the occurrence of EP（ OR=11. 457, P=0. 000;OR=3. 479, P=0. 002）. When endometrial thickness was more than or equal to 7. 5 mm, the risk of tubal pregnancy decreased obviously（OR=10. 463, P=0. 002）. Conclusion The main correlative factors with EP are tutal path-ological and pelvis changes, endometriosis or endometriosis postoperatively and the thickness of endometrium in the day of embryo transfer. In addition, sera hCG level tests and transvaginal ultrasonography are recommended for ear-ly diagnosis.