输卵管积水患者行宫腔镜输卵管栓塞术后体外受精-胚胎移植临床结局分析

Reproductive outcome of IVF-ET after hysteroscopic tubal occlusion for hydrosalpinx.

目的评估输卵管积水患者宫腔镜输卵管栓塞术后体外受精-胚胎移植(IVF-ET)的临床结局。方法收集2012年6月1日至2017年6月1日因“单侧或双侧输卵管积水合并不孕症”于北京大学第三医院生殖医学中心行宫腔镜输卵管弹簧圈栓塞术并行IVF-ET的患者81例为组A;以年龄和基础血清卵泡刺激素(FSH)水平匹配同期因输卵管积水行腹腔镜输卵管切除术的患者397例为组B;超声和子宫输卵管造影(HSG)提示输卵管积水但未行输卵管手术而进入IVF-ET周期的患者129例为组C。收集3组患者的临床资料,回顾性分析IVF-ET的结局。结果共135例输卵管积水患者因盆腔严重粘连等原因行宫腔镜输卵管弹簧圈栓塞术,每根输卵管栓塞的成功率为98.23%(222/226)。其中1例(0.74%,1/135)患者术后半年发生输卵管脓肿。3组间年龄、窦卵泡计数、BMI、基础血清FSH水平、不孕年限均差异无统计学意义。组A与组B、C在控制性促排卵后获卵数[(13.28±7.46)个vs.(13.72±7.78)个vs.(12.42±5.15)个]、2PN数[(8.02±5.08)个vs.(8.01±5.42)个vs.(7.86±3.72)个]、可移植胚胎数[(5.75±4.53)个vs.(5.83±5.16)个vs.(5.40±2.88)个]方面差异均无统计学意义(P>0.05)。与组B相比,组A新鲜周期卵裂胚移植后临床妊娠率(29.0%vs.46.5%,P=0.011)和活产率(22.6%vs.37.9%,P=0.022)显著降低;与组C相比,组A临床妊娠率和活产率显著提高(29.0%vs.12.5%,P=0.010;22.6%vs.9.4%,P=0.022)。结论对输卵管积水合并不孕症患者行宫腔镜输卵管栓塞术可以改善IVF-ET的临床妊娠结局,但是仍劣于腹腔镜输卵管切除术。

Objective To evaluate the reproductive outcomes of in vitro fertilization-embryo transfer(IVF-ET)after hysteroscopic tubal occlusion in women with hydrosalpinx.Methods A total of 81 women diagnosed with uni-or bilateral hydrosalpinx underwent hysteroscopic proximal tubal occlusion with fibered platinum coil(Tornado)from June 1st,2012 to June 1st,2017 prior to IVF-ET were included as group A.Matched by age and basal serum FSH level,397 patients who underwent laparoscopic salpingectomy due to hydrosalpinx were included as group B,and 129 patients with unilateral or bilateral hydrosalpinx diagnosed by ultrasound and hystero-salpingography who didn’t accept any fallopian surgery in the same period before IVF-ET were included as group C.The clinical data of the 3 groups were collected and the reproductive outcomes of IVF-ET were evaluated retrospectively.Results A total of 135 patients with hydrosalpinx and severe pelvic adhesion underwent hysteroscopic proximal tubal occlusion with fibered platinum coil(Tornado).The rate of each successful occlusion was 98.23%(222/226).One woman developed pyosalpinx(0.74%,1/135)half a year after the surgery.Among three groups,there were no statistical difference in age,antral follicle count(AFC),BMI,basic serum follicle stimulating hormone(FSH)or infertility duration,and the number of oocytes retrieved(13.28±7.46)vs.(13.72±7.78)vs.(12.42±5.15),2PN(8.02±5.08)vs.(8.01±5.42)vs.(7.86±3.72)and available embryos(5.75±4.53)vs.(5.83±5.16)vs.(5.40±2.88)were not statistically different(P>0.05).In group A,fresh day-3 ET resulted in a clinical pregnancy rate of 29.0%(18/62)and a live birth rate of 22.6%(14/62),significantly lower when compared with group B(46.5%,P=0.011;37.9%,P=0.022),while higher than group C(12.5%,P=0.010;9.4%,P=0.022).Conclusion The hysteroscopic tubal occlusion can improve the clinical outcome of IVF-ET in women with hydrosalpinx;however,it is still inferior when compared with laparoscopic salpingectomy.