输卵管及卵巢手术对体外受精——胚胎移植结局的影响

The effection of uterine adnexectomy to the outcome of IVF-ET

[目的]探讨输卵管及卵巢手术对体外受精-胚胎移植(IVF-ET)结局的影响。[方法]对157例162周期因不孕行IVF-ET的患者按以往手术史分为输卵管手术组(46例),卵巢手术组(19例)及非手术组(97例)。比较其基础FSH值、平均Gn用量、平均获卵数、受精、卵裂及妊娠率。在卵巢手术组中比较一侧卵巢切除与部分卵巢切除的上述指标。[结果]①血FSH基值卵巢手术组高于输卵管手术组与非手术组,但无统计学差别;一侧卵巢切除者显著高于部分卵巢切除者(P<0.01)。②Gn的平均用量手术组高于非手术组,但无统计学差别。③妊娠率卵巢手术组显著低于输卵管手术组与非手术组(P<0.01),一侧卵巢切除组平均获卵数及妊娠率均显著低于卵巢部分切除者(P<0.01)。④输卵管积水的患者切除积水的输卵管后可显著提高妊娠率但Gn用量也明显增加。[结论]①输卵管、卵巢手术后IVF-ET患者需增加促超排卵药物的用量。②卵巢手术尤其是一侧卵巢切除者可明显降低获卵数及妊娠率。③切除积水的输卵管有助于提高IVF-ET的成功率。

[Objective] To evaluate the outcome of IVF-ET in women who had experienced uterine adnexectomy. [Methods] 46 women who had undergone salpingectomy, 19 ovariectomy compared to 97 non-operation women regarding basic FSH levels, the doses of gonadotropin in control ovarian hyperstimulation (COH), the number of oocytes retrieved and the rates of fertilization, cleavage and pregnancy. [Result] ①The basic FSH levels were higher in ovariectomy group than that in salpingectomy and non-operation group. Unilateral ovariectomy group had higher FSH levels than that partial ovariectomy group. ②Operation groups (including ovariectomy and salpingectomy) tend to use more gonadotropin in COH than non-operation group. ③Ovariectomy group had the lowest pregnancy rate especially in unilateral ovariectomy patients. ④Patients with hydrosalpines would have higher pregnancy rate after salpingectomy. [Conclusion] ① Uterine adnexectomy may increase the dose of gonadotropin in COH during IVF-ET cycles. ② Patients who had undergone ovarian operation tend to have fewer number of oocytes retrieved and pregnancy rate.