异位妊娠后行体外受精-胚胎移植的临床结局分析

Pregnancy outcome in IVF-ET patients with previous ectopic pregnancy

目的探讨异位妊娠（EP）后行体外受精-胚胎移植（IVF-ET）的临床结果以及EP次数及输卵管治疗方法对妊娠结局的影响。方法回顾性分析2012年1~12月在我中心行IVF-ET的患者,选择经腹腔镜或输卵管碘油造影诊断为盆腔、输卵管因素性不孕症患者的401个周期,根据既往有无EP史,分为EP组270周期和非EP组131周期;EP组又根据既往EP的发生次数分为EP1次组和EP≥2次组。分别比较EP组和非EP组、EP1次组和EP≥2次组的种植率、妊娠率以及重复异位妊娠（REP）的发生率。同时根据输卵管治疗方法的不同,分别比较患侧输卵管结扎或根治性手术组（A组）和患侧输卵管保守手术组（B组）以及对侧输卵管结扎或根治性手术组（A1组）和对侧输卵管保留组（A2组）的临床结局。结果 （1）EP组与非EP组促性腺素激素（Gn）用量、Gn天数、子宫内膜厚度、获卵数比较,差异无统计学意义（P〉0.05）,两组的妊娠率、种植率及EP发生率比较,亦无统计学差异（P〉0.05）。（2）EP1次组和EP≥2次组的妊娠率、EP发生率比较,无统计学差异（P〉0.05）;EP≥2次组的种植率（72.04%）明显高于EP1次组（50.12%）,差异有统计学意义（P〈0.01）。（3）A、B两组的妊娠率、种植率及EP发生率比较无显著性差异（P〉0.05）;A1组的妊娠率（87.14%）和种植率（59.03%）明显高于A2组的妊娠率（65.22%）和种植率（43.31%）,差异有统计学意义（P〈0.01）。结论本研究结果提示EP后行IVF-ET并不影响临床妊娠结局,亦不增加REP的风险,且与既往EP次数无关。患侧输卵管保守手术或根治性手术治疗均不影响妊娠率,不增加REP的风险;对侧输卵管是否保留,则应进行综合评估后判定。对既往发生2次以上EP的患者,双侧输卵管切除更有利于改善妊娠结局。

Objective：To investigate the pregnancy outcome in IVF-ET patients with previous ectopic pregnancy（EP）.Methods：The data of 401IVF-ET cycles in the patients with tubal factors from January 2012 to December 2012 were retrospectively analyzed.The status of the fallopian tubes of the patients was confirmed by laparoscopy or hysterosalpingogram.The patients were divided to two groups according to EP history：EP group（270cycles）and non-EP group（131cycles）.The patients in the EP group were subdivided into two groups according to the frequency of EP：EP once（EP1）group and EP≥2group.The implantation rate,pregnancy rate and repeat ectopic pregnancy（REP）rate were compared among the three groups.In addition,the pregnant outcomes were analyzed in the patients whose EP was treated by surgery or conservative method.Results：There was no significant difference with regard to the pregnancy rate,implantation rate EPrate,as well as dose of gonadotropin（Gn）used,Gn days,endometrial thickness,and number of oocytes retrieved between EP group and control group（all P〉0.05）.The implantation rate was significantly higher in patients with EP≥2compared to the patients with EP1（72.04% vs.50.12%,P〈0.01）,while there was no difference in pregnancy rate and incidence of EP（P〉0.05）.No matter whether the previous EP was treated conservatively or surgically,the pregnancy outcomes were not affected.Ligation or excision of contralateral fallopian tube improved the pregnancy rate（87.14% vs.59.03%）and implantation rate（65.22% vs.43.31%）（P 0.01）,but did not reduce the recurrent EP rate compared with the contralateral fallopian tube treated by conservative method.Conclusions：A previous history of EP did not affect IVF outcomes and REP risk,regardless of the frequency of EP.No matter whether the previous EP was treated conservatively or surgically,the pregnancy outcome and REP risk were not affected.Whether or not the contralateral fallopian tube is retained,it should be carried out decision after the comprehensive evaluation.If previously more than 2 times of EP of patients,bilateral salpingectomy is more advantageous to improve the outcome of pregnancy.