体外受精-胚胎移植术后异位妊娠18例临床分析

目的探讨体外受精-胚胎移植术后异位妊娠的相关高危因素、发生率及诊断方法。方法回顾性分析我院收治的行体外受精-胚胎移植(IVF-ET)术后异位妊娠患者18例的临床资料。结果 IVF-ET术后临床妊娠者共计541例,发生异位妊娠者18例(3.33%),其中发生宫内外同时妊娠者4例(7.39%)。异位妊娠组的近距离胚胎移植率、输卵管因素明显高于宫内妊娠组,差异有统计学意义(P0.05)。结论 IVF-ET后异位妊娠的重要高危因素就是输卵管因素,并且和宫内移植管顶端的位置有关系。在IVF-ET术后及手术过程中采取相应处理措施,以及早期的诊断与处理能降低其产生的危害。     

体外受精-胚胎移植技术中74例异位妊娠的临床分析

目的:分析体外受精-胚胎移植(in vitro fertilization and embryo tranfer,IVF-ET)助孕技术中发生异位妊娠的影响因素、诊断、治疗方法及预防措施。方法:回顾性分析IVF-ET助孕技术中发生异位妊娠74例患者的临床资料。结果:所有接受IVF-ET的1 585患者中,共发生异位妊娠74例,异位妊娠发生率为4.67%;异位妊娠类型中输卵管妊娠71例,占总异位妊娠的95.95%。新鲜胚胎移植周期组异位妊娠发生率(5.41%)显著性高于冷冻胚胎复苏移植(frozing embryo transfer,FET)周期组(2.35%)(P<0.05)。移植深度距离宫底>1.2 cm时异位妊娠发生率显著性低于移植深度0.8~1.2 cm组。结论:IVF-ET助孕技术中异位妊娠发生率较自然妊娠过程中高;输卵管因素、促排卵药物的应用以及胚胎移植的深度是异位妊娠发生的主要影响因素。     

体外受精—胚胎移植后异位妊娠58例分析

目的:探讨体外受精-胚胎移植(IVF-ET)后异位妊娠(EP)的高危因素。方法:对接受体外受精胚胎移植(IVF-ET)助孕后发生异位妊娠病例的助孕指征、助孕方式等进行回顾性分析。结果:2009年1月至2010年12月佛市妇幼保健院行体外受精胚胎移植(IVF-ET)2445个周期,1153个周期临床妊娠,发生率47.16%,异位妊娠58个周期,发生率为5.03%。年龄、促性腺激素总量、取卵数、移植胚胎个数及优质胚胎率与本次助孕后异位妊娠的发生无关(P>0.05)。49例患者助孕指征为输卵管因素和/或盆腔粘连,占84.48%。2种助孕方式(IVF-ET,ICSI)比较,总妊娠率差异无统计学意义(P>0.05),2种助孕方式异位妊娠率比较,差异亦无统计学意义(P>0.05)。结论:输卵管因素是异位妊娠发生的高危因素,与年龄、促性腺激素总量、取卵数、移植胚胎个数、优质胚胎率、助孕方式无关。     

辅助生殖技术后异位妊娠82例临床分析

目的:探讨接受辅助生殖技术(ART)后异位妊娠患者的临床情况及高危因素.方法:对我院2005年1月至2008年10月接受体外受精一胚胎移植(IVF-ET)、卵母细胞内单精子注射(ICSI)、冻融胚胎移植(F-ET)治疗后发生异位妊娠的病例进行回顾性分析.结果:ART治疗5141个周期获临床妊娠1176例的患者中异位妊娠82例,占6.97%(82/1176),其中输卵管妊娠72例,占临床妊娠的6.12%(72/1176),占总异位妊娠的比例为87.8%(72/82).因输卵管因素行ART共3101周期,发生异位妊娠63例,发生率2.03%(63/3101);非输卵管因素行ART 2040周期,发生异位妊娠19例,发生率0.93%(19/2040).3种ART方式(IVF-ET、ICSI、F-ET)异位妊娠发生率比较,IVF显著高于ICSI和F-ET.结论:输卵管因素是ART后发生异位妊娠的高危因素.     

体外受精 - 胚胎移植后异位妊娠的危险因素、诊断及治疗

目的　探讨体外受精 -胚胎移植 (IVF-ET)后异位妊娠 (EP)的危险因素、诊断及治疗方法。方法　对我院 1992年 10月～ 2 0 0 2年 6月接受体外受精-胚胎移植治疗 (包括单精子胞浆内注射 ,ICSI)后 82 1例临床妊娠中 38例异位妊娠进行回顾性分析。结果　IVF -ET后异位妊娠的发生率 4 6 % ,多胚胎不同部位妊娠(HP)的发生率 0 6 %。异位妊娠组取卵数明显多于对照组。单因素分析发现异位妊娠史、盆腔炎性疾病 (PID)史是IVF-ET后异位妊娠的危险因素。结论　盆腔炎性疾病史、异位妊娠史是IVF -ET后异位妊娠的高危因素。胚胎移植后妇女激素水平可能与异位妊娠的发生相关 ,但需进一步的研究证实。早期诊断和微创性治疗 ,减少异位妊娠的并发症和死亡率     

体外受精-胚胎移植术后复合妊娠8例临床分析

目的:探讨体外受精-胚胎移植(IVF-ET)术后复合妊娠的早期诊断、及时处理的临床意义。方法:回顾性分析2001年1月至2006年7月我院收治的8例IVF-ET术后复合妊娠病例。结果:早期诊断、及时行腹腔镜治疗的2例患者,宫内妊娠结局良好;延误诊断的3例和诊断复合妊娠而患者及家属拒绝手术的3例,宫内胚胎均停止发育,延误诊断的3例中1例发生大量内出血、休克,抢救成功。结论:IVF-ET术后的复合妊娠的早期诊断、及时治疗异位妊娠,有利于防止预后不良,腹腔镜下输卵管(部分)切除术是治疗复合妊娠的首选方法。     

宫腔镜检查IVF-ET不同妊娠结局的宫腔情况比较和再次妊娠结局分析

目的:观察体外受精-胚胎移植(IVF-ET)不同妊娠结局的宫腔情况以及对异常宫腔患者治疗后的再妊娠情况.方法:回顾性分析行宫腔镜检查的582例IVF-ET病例,A组IVF-ET周期前常规宫腔镜检查223例,B组ET后发生异位妊娠18例,C组1次或多次ET未孕225例,D组ET后早期自然流产116例,B、C、D组不良妊娠结局发生后均做宫腔镜检查.比较4组宫腔镜检查的结果,并对发现宫腔异常者进行相应的治疗,观察治疗后的IVF-ET妊娠结局.结果:A组宫腔镜检查宫腔异常率低于B、C、D组(P＜0.05),D组中宫腔粘连发生率显著高于A、B、C组(P＜0.01).异常宫腔经治疗后妊娠率46.45％,异位妊娠率3.53％,早孕自然流产率12.94％.结论:对于IVF-ET助孕发生不良妊娠结局的患者,应将宫腔镜检查列为IVF-ET前的常规检查,以提高重复周期的临床妊娠率和着床率,进而提高活胎分娩率.     

体外受精-胚胎移植术后异位妊娠19例临床分析

目的:探讨体外受精-胚胎移植术后异位妊娠的病因、诊断及治疗方法。方法:对2003.06-2005.02间经体外受精-胚胎移植收入我院治疗的异位妊娠(EP)病例共19例进行回顾性分析。结果:宫内外同时妊娠(HP)4例,宫角妊娠2例,单纯异位妊娠16例。病例中输卵管因素16例(84.21%),非输卵管因素3例(15.79%),一次以上人流史12例(63.16%),曾有异位妊娠史者6例(31.58%)。术后双侧输卵管被切除者共14例(73.68%)。结论:输卵管炎症、既往多次异位妊娠史和多次人流史是体外受精-胚胎移植术后异位妊娠的高危因素,早期的血β-hCG值结合阴道超声检查能及时准确地早期发现异位妊娠。目前临床多采用电视腹腔镜(TV-LP)下双侧输卵管切除术以降低EP的再发生。     

子宫异位妊娠应用刨削系统治疗的临床疗效观察

目的:评估子宫异位妊娠应用刨削系统(IBS)宫腔镜手术治疗的临床疗效。方法:回顾性分析2014年1月至2016年9月在北京大学第三医院生殖医学中心接受体外受精-胚胎移植(IVF-ET)后发生子宫异位妊娠的8例患者,通过IBS进行手术治疗的临床结局。结果:8例患者发现异位妊娠的中位时间是胚胎移植后25.75天。8例患者手术均顺利完成,完全清除病灶,手术时间21~48分钟,平均30.86分钟;手术出血量5~20 ml,无一例发生子宫穿孔、液体超负荷等并发症。术后1个月复查超声,均未见妊娠组织残留,术后2个月内血β-HCG下降至正常范围。结论:IBS治疗部分、早期子宫异位妊娠临床效果好,且微创、安全。     

体外受精-胚胎移植后宫内宫外复合妊娠的诊治探讨

目的 探讨体外受精一胚胎移植(IVF-ET)后宫内宫外复合妊娠的危险因素、诊断及治疗。方法 回顾性分析我院1993年1月～2002年12月收治的11例IVF-ET后宫内宫外复合妊娠病例。结果 11例患者中10例移植3个及3个以上胚胎，10例有盆腔粘连和／或输卵管阻塞病史，症状以腹痛常见的有10例，失血性休克2例，B超确诊1例，提示宫内妊娠合并附件包块9例，1例无症状者于剖宫产时发现陈旧性宫外孕，7例宫内胚胎存活者分别行异位妊娠病灶穿刺抽吸(1例)、输卵管修补或切除术(6例)，共有5例活产。结论 对有盆腔和输卵管疾病史，IVF-ET术后出现腹痛，B超提示子宫旁肿块者，要注意宫内宫外复合妊娠的可能，尽早减灭异位妊娠胚胎有利于防止预后不良。     

An analysis of factors associated with ectopic pregnancy following in vitro fertilization and embryo transfer

Five ectopic pregnancies occurred in 75 in vitro fertilization and embryo transfer (IVF-ET) pregnancies (6.7%) in Ogikubo Hospital IVF program between 1985 and 1989. The indication for IVF in 70 pregnancies was a tubal factor. Thirty cases were among 70 pregnancies with hydrosalpinx, and 40 cases were with other tubal conditions. All of the five cases had tubal disease. Four of them had hydrosalpingos. The percentage of ectopic pregnancies for the 30 pregnancies with hydrosalpinx was 13.3%, while for 40 pregnancies with other tubal conditions it was 2.5%. However, there was no significant difference between the two groups. No correlation was found in other parameters including superovulatory methods, oocyte recovery procedure, number of embryos transferred, embryo transfer procedure, and endocrine changes after embryo transfer. In this study, we were unable to identify a difference between ectopic pregnancy and intra-uterine gestation in IVF-ET. However, further study is required to clarify whether hydrosalpinx increases the risk of ectopic pregnancy in IVF-ET.     

The role of tubal pathology and other parameters in ectopic pregnancies occurring in in vitro fertilization and embryo transfer

Contradictory findings were reported concerning the role of tubal disease in the genesis of ectopic pregnancy in in vitro fertilization and embryo transfer (IVF-ET). We report on six ectopics that occurred in 141 IVF-ET pregnancies (4.3%). All of the six cases were among 84 patients with tubal disease, and none occurred in the remaining 57 patients with other etiological factors. No correlation was found in other parameters including: ovulation induction, number of embryos transferred, and luteal support. A comparison between the ectopics and six matched controls demonstrated similar estradiol levels, but beta-hCG levels on day 15 to 17 after ET were lower. Homolateral salpingectomy was performed in all six cases, but a contralateral resection was carried out in three of them. More comprehensive studies are needed to clarify whether tubal pathology really increases the risk for ectopic gestation in IVF-ET.     

体外受精与胚胎移植前输卵管积水处理方式的探讨

目的:探讨体外受精与胚胎移植(IVF-ET)前输卵管积水的不同处理方式对IVF-ET结局的影响。方法:回顾分析2002年1月至2004年12月因输卵管因素不孕接受IVF-ET治疗的346个治疗周期的资料。按输卵管的情况分为4组,A组:输卵管阻塞,未发现输卵管积水者,共151个治疗周期;B组:IVF-ET前输卵管积水未行手术治疗者,共73个治疗周期;C组:IVF-ET前输卵管积水行输卵管伞端造口术者,共43个治疗周期;D组:IVF-ET前输卵管积水行输卵管切除术者,共79个治疗周期。结果:各组的临床妊娠率分别为48.34%、21.92%、34.88%、44.30%,异位妊娠率分别为1.37%、12.50%、6.67%、2.86%,种植率分别为20.36%、5.87%、12.28%、19.38%,B组的临床妊娠率及种植率较A组、D组明显降低,B组、C组的异位妊娠率均较A组、D组升高。结论:输卵管积水对IVF-ET的结局有负面影响,IVF-ET前输卵管积水,先行手术治疗,可改善IVF-ET的结局。较之输卵管造口术,输卵管切除术可减少异位妊娠的发生率及输卵管积水的复发率。     

支原体对输卵管性不孕患者体外受精与胚胎移植结局的影响

目的 :探讨输卵管不孕患者中宫颈解脲支原体 ( UU)感染对体外受精与胚胎移植 ( IVF-ET)结局的影响。方法 :回顾性分析本中心于 1 999年 3月～ 2 0 0 0年 1月因输卵管因素不孕进行常规IVF-ET治疗的患者 ,据宫颈分泌物 UU培养的结果及药物治疗后的结果分为 :2 5 7周期的 UU阴性组 ( A组 )、3 6周期的 UU治疗后转阴组 ( B组 )和 5 0周期 UU治疗后仍阳性组 ( C组 )。比较各组间受精率、卵裂率、优质胚胎率、临床妊娠率、种植率、异位妊娠发生率和流产率 ,行统计学分析。结果 :三组间受精率、卵裂率、优质胚胎率、临床妊娠率、种植率和流产率差异无统计学意义 ( P>0 .0 5 ) ,但 C组异位妊娠发生率较 A和 B组高 ( P<0 .0 5 )。结论 :IVF-ET中 ,输卵管因素不孕患者的宫颈分泌物 UU阳性 ,异位妊娠的发生率有增高趋势 ,但对胚胎发育、临床妊娠率、种植率及流产率无显著影响 ,经药物治疗 UU转阴后则对 IVF的结局无影响。     

Rare presentation of ectopic pregnancy following IVF-ET: live twin gestation in the same fallopian tube

We report a case of a twin ectopic pregnancy (EP) after in vitro fertilization and embryo transfer (IVF-ET). A 24-year-old nulligravida presented with lower abdominal pain and vaginal bleeding 4 weeks after embryo transfer. Serum β-HCG levels were 40 IU/mL, 90 IU/mL, and 1970 IU/mL on ET days 12, 14, and 23, respectively. Ultrasound examination revealed two ectopic gestational sacs with fetal heart beats in the left adnexa, without evidence of intrauterine pregnancy. At laparoscopy, one isthmic and another ampullary sac were detected in the left tube and left salpingectomy was performed. The patient was discharged healthy on postoperative day 2. Albeit extremely rare, ectopic pregnancies with abnormal presentation can be encountered following IVF-ET. Single embryo transfer may be advised to protect from ectopic pregnancies after IVF-ET.     

Simultaneous tubal and intra-uterine pregnancy following in vitro fertilization and embryo transfer

A case of simultaneous ectopic and intra-uterine pregnancy following in vitro fertilization and embryo transfer (IVF-ET) is described. On day 56 after ET the tubal pregnancy ruptured, with massive hemoperitoneum. Following salpingectomy, the intra-uterine pregnancy continued to term when delivery was carried out by cesarean section owing to non-progress of labor and suspected fetal distress. The pitfalls in diagnosing a simultaneous pregnancy of this kind following IVF-ET are discussed.     

Simultaneous bilateral tubal pregnancies after in vitro fertilization and embryo transfer: report of a case.

Ectopic pregnancies continue to be a major complication of in vitro fertilization and embryo transfer (IVF-ET). A case of bilateral simultaneous tubal pregnancy after IVF-ET is described. The patient underwent ovum pick-up (OPU) through a laparotomy with concomitant pelvic surgery. Embryo transfer (ET) was performed two days after OPU; this resulted in bilateral tubal pregnancies, diagnosed and treated one month apart. There are several possible causal mechanisms for the increased rate of ectopic pregnancies following IVF-ET. It is important to recognize that care in the transfer technique, with respect to the catheter position and limiting the volume of transfer medium to 20 microL, and an awareness of previous occlusion of the tubal ostia, or of a salpingectomy before IVF-ET, can help to minimize this complication rate. Two important points are the possibility of a simultaneous bilateral tubal pregnancy after IVF-ET, and the necessity of carefully examining both adnexa at the time of surgery for an ectopic pregnancy. Early and accurate diagnosis of a simultaneous bilateral ectopic pregnancy can prevent the necessity of a second operation and reduce maternal morbidity and mortality.