宫颈LEEP术对不孕患者IVF/ICSI助孕结局的影响

The effect of cervical LEEP surgery on IVF/ICSI assisted pregnancy outcome in infertility patients

目的探讨宫颈环形电切手术(loop electrosurgical excision procedure,LEEP)对不孕症患者卵巢功能及IVF/ICSI助孕过程和结局的影响。方法应用回顾性队列研究,将2018年1月至2020年12月湘潭市中心医院行宫颈LEEP术后同时合并不孕症患者46例作为研究组,同期非宫颈手术不孕症患者242例作为对照组。结果两组之间年龄、不孕因素、AMH值、获卵数、受精率、优胚率、胚胎着床率、临床妊娠率、早期流产率、晚期流产率、单胎妊娠剖宫产率、解冻胚胎移植前内膜下血流PI值、S/D值差异均无统计学意义(P>0.05)。研究组孕次、人工流产次数均较对照组高(P<0.05),研究组较对照组每冻胚移植前内膜厚度更薄、移植前内膜下血流支数更少(P<0.05)。研究组移植胚胎数明显少于对照组(P<0.05),减胎率及宫颈环扎手术率明显高于对照组(P<0.05),单胎中因宫颈因素早产或流产率,较对照组高(P<0.05)。结论宫颈LEEP术不影响不孕症患者IVF/ICSI助孕过程中的卵巢功能及胚胎质量,但LEEP术有可能影响患者解冻胚胎移植前的内膜厚度。建议对于宫颈术后的患者减少胚胎移植个数、加强宫颈机能评估、必要时行宫颈环扎手术来增加单胎足月活产的概率。

Objective To investigate the effect of cervical loop electrosurgical excision procedure(LEEP)on ovarian function,IVF/ICSI assisted pregnancy process and outcome in infertile patients.Methods A retrospective cohort study was conducted on 46 patients with infertility after cervical LEEP in Xiangtan Central Hospital from May 2018 to December 2020 as the study group,and 242 patients with infertility after non-cervical surgery as the control group.Results There was no significant difference between the two groups in age,infertility factors,AMH value,number of eggs,fertilization probability,excellent embryo probability,embryo implantation probability,clinical pregnancy probability,early abortion probability,late abortion probability,cesarean section probability,PI value and S/D ratio of subintimal blood flow before thawed embryo transfer(P>0.05).The times of pregnancy and abortion in the study group were higher than those in the control group(P<0.05).Compared with the control group,the intima thickness of each frozen embryo before transplantation was thinner and the number of subintimal blood flow before transplantation was less in the study group(P<0.05).The number of transferred embryos in the study group was significantly less than that in the control group(P<0.05),and the fetal reduction rate and cervical cerclage operation rate were significantly higher than those in the control group(P<0.05).The rate of premature birth or miscarriage due to cervical factors in single pregnancies is higher than that in the control group(P<0.05).Conclusion Cervical LEEP does not affect the ovarian function and embryo quality of infertile patients during IVF/ICSI assisted pregnancy,but LEEP may affect the intimal thickness of patients before thawing embryo transfer.For patients after cervical surgery,wes recommended to reduce the number of embryo transfer,strengthen cervical function evaluation,and perform cervical cerclage when necessary to increase the probability of single term live birth.