输卵管积液对高龄女性体外受精-胚胎移植妊娠结局的影响

Adverse effects of the hydrosalpinx on IVF-ET outcomes among women with advanced age

目的探讨输卵管积液对高龄女性体外受精-胚胎移植(IVF-ET)妊娠结局的影响。方法回顾性分析2014年1月至2020年4月因不孕症合并输卵管积液于西北妇女儿童医院行IVF-ET助孕的90例高龄妇女(≥35岁)的临床资料,按照胚胎移植前是否行进行了输卵管积液手术治疗分为手术组(n=62)和未手术组(n=28)。主要观察指标为临床妊娠率和活产率,次要观察指标为HCG阳性率、胚胎种植率、异位妊娠率和流产率。结果手术组平均胚胎移植数目显著高于未手术组[(1.79±0.41)vs.(1.50±0.51),P=0.011]。手术组临床妊娠率(58.06%vs.21.43%,P<0.001)和活产率(46.77%vs.10.71%,P=0.001)均显著高于未手术组。次要观察指标中,手术组HCG阳性率(62.90%vs.28.57%,P=0.003)和胚胎种植率(36.94%vs.14.29%,P=0.007)显著高于未手术组。两组间异位妊娠率和流产率均无统计学差异(P>0.05)。在校正了移植胚胎数目后,手术组临床妊娠率和活产率仍显著高于未手术组(P<0.05)。结论胚胎移植前手术处理输卵管积液可改善高龄不孕症女性的IVF-ET妊娠结局,建议高龄不孕症女性胚胎移植前手术处理输卵管积液。

Objective:To investigate the effects of the hydrosalpinx on IVF-ET outcomes among women with advanced age.Methods:The clinical data of the infertile women(aged 35 years or over)with hydrosalpinx who underwent IVF-ET in Northwestern Women’s&Children’s Hospital ART center were retrospectively analyzed.The patients were divided into operation group(n=62)and non-operation group(n=28).The main outcomes were clinical pregnancy rate and live birth rate.The secondary outcomes were HCG positive rate,implantation rate,ectopic pregnancy rate and miscarriage rate.Results:The average number of embryo transferred in the operation group was significantly higher than that of the non-operation group[(1.79±0.41)vs.(1.50±0.51),P=0.011].Meanwhile,the clinical pregnancy rate(58.06%vs.21.43%,P<0.001)and live birth rate(46.77%vs.10.71%,P=0.001)of the operation group were significantly higher than those of the non-operation group.Among the secondary outcomes,the HCG positive rate(62.90%vs.28.57%,P=0.003)and implantation rate(36.94%vs.14.29%,P=0.007)of the operation group were significantly higher than those of the control group.There was no significant difference in ectopic pregnancy rate and abortion rate between the two groups(P>0.05).After adjusted the number of embryos transferred,the clinical pregnancy rate and live birth rate of the operation group were still significantly higher than those of the non-operation group(P<0.05).Conclusions:Surgical treatment of hydrosalpinx before embryo transfer can improve the IVF-ET pregnancy outcome in infertile women with advanced age.It is suggested that the operation of hydrosalpinx should be carried out before embryo transfer in infertile women with advanced age.