输卵管积水患者介入栓塞术后行体外受精-胚胎移植临床妊娠结局影响因素分析

Analysis of influencing factors on clinical pregnancy outcomes in patients with hydrosalpinx undergoing in vitro fertilization-embryo transfer after interventional embolization

目的探讨输卵管积水患者介入栓塞术后行体外受精-胚胎移植(IVF-ET)临床妊娠结局影响因素及残存积水对妊娠结局的影响。方法回顾性收集2021年3月至2022年10月于郑州大学第三附属医院因输卵管积水行介入栓塞术且行IVF-ET的65例患者的临床资料,以术中积水处最宽径与盆腔横径比值量化积水指数,记录患者移植时年龄、体重指数(BMI)、卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、抗缪勒管激素(AMH)、移植时子宫内膜厚度、移植胚胎个数、胚胎类型、输卵管积水位置等数据,随访至栓塞术后首次移植临床妊娠结局。采用SPSS 25.0进行数据分析,采用两独立样本t检验、秩和检验和卡方检验分析不同妊娠结局间上述指标的差异。采用受试者操作特征(ROC)曲线和约登指数计算积水指数截断值。结果65例患者中临床妊娠率为63.1%(41/65),其中于栓塞前已行胚胎移植且未成功的45例患者栓塞术后临床妊娠率为62.2%(28/45)。数据分析表明IVF-ET临床妊娠结局与年龄、BMI、FSH、LH、E2、AMH、移植时子宫内膜厚度、移植胚胎个数、胚胎类型以及输卵管积水位置无相关性(P>0.05),与输卵管积水指数存在相关性(P<0.001)。ROC曲线分析表明积水指数可以作为妊娠结局的预测指标,曲线下面积为0.825,约登指数分析结果显示积水指数的最优截断值为12.925%。结论输卵管积水行介入栓塞治疗可提高IVF-ET临床妊娠率,但当患者当积水指数较大时对IVF-ET临床妊娠产生不利影响,在移植之前应对输卵管积水进行进一步抽吸处理。

ObjectiveTo explore the influencing factors of clinical pregnancy outcomes in patients with hydrosalpinx undergoing in vitro fertilization-embryo transfer(IVF-ET)after interventional embolization and whether residual hydrops has an adverse impact on pregnancy outcomes.MethodsClinical data from 65 patients who underwent interventional embolization and IVF-ET for hydrosalpinx at the Third Affiliated Hospital of Zhengzhou University from March 2021 to October 2022 were collected retrospectively.The hydrops index was quantified by the ratio of the widest diameter to the pelvic transverse diameter of the intraoperative hydrops,and the patient′s age,body mass index(BMI),follicle-stimulating hormone(FSH),lutenizing hormine(LH),estradiol(E2),automated matetials hangling(AMH),endometrial thickness at the time of transplantation,the number of transplanted embryos,embryo type,and location of the hydrosalpinx were recorded.In addition,the clinical pregnancy outcomes of the first transplantation after embolization were followed.Two independent samples t-test,rank sum test and chi-square test were used to analyze the difference of the above indexes among different clinical pregnancy outcomes by SPSS 25.0.The receiver operating characteristic(ROC)curves and Youden index were used to calculate the cut-off value of the water accumulation index.ResultsAmong 65 patients,the clinical pregnancy rate was 63.1%(41/65),among the 45 patients who underwent embryo transfer before embolization without success,the clinical pregnancy rate after embolization was 62.2%(28/45).Based on data analysis,it showed that IVF-ET clinical pregnancy outcomes were not associated with age,BMI,FSH,LH,E2,AMH,endometrial thickness at the time of transplantation,the number of transplanted embryos,embryo type,as well as location of hydrosalpinx(P>0.05),but associated with hydrosalpinx index(P<0.001).ROC curve analysis showed that the hydrops index could be used as a predictor of pregnancy outcome,and the area under the curve was 0.825,and the optimal cut-off value of the hydrops index was 12.925% based on the Youden index analysis result.ConclusionsInterventional embolization of hydrosalpinx may improve clinical pregnancy rates.When the hydrosalpinx is large enough,it could adversely affected IVF-ET clinical pregnancy,and further aspiration of hydrosalpinx should be performed prior to transplantation.