输卵管手术对控制性超排卵时卵巢反应性的影响

目的:探讨IVF-ET中不同的输卵管手术方式对控制性超排卵(COH)过程中患者卵巢反应性的影响。方法:回顾性分析长方案超排卵IVF周期临床资料,选择397例因输卵管因素不孕患者,其中手术组176例,非手术组221例;手术组患者均因输卵管妊娠或输卵管阻塞、粘连或积水行单侧或双侧输卵管切除或输卵管修复整形手术,其中单侧输卵管切除组70例(A组),双侧输卵管切除组46例(B组),单侧输卵管整形组27例(C组),双侧输卵管整形组33例(D组);非手术组均未为双侧输卵管阻塞无积水患者,作为对照组(E组)。比较各组的临床资料、卵巢对促排卵的反应性和妊娠结局。结果:B组基础FSH值显著高于E组(P<0.05),卵泡数(直径≥15mm)、获卵数显著低于E组(P<0.05)。A组术侧卵巢卵泡数(直径≥15mm)和获卵数明显少于健侧卵巢(P<0.05)。但输卵管手术不影响IVF-ET,各组的的妊娠率和种植率无统计学差异。结论:输卵管切除降低了卵巢超排卵时的反应性,手术可能影响卵巢的血供进而影响卵巢对COH的反应。

Effects of Operation on Fallopian Tube on Ovarian Response during Controlled Ovarian Hyperstimulation

Objective: To investigate the effects of different operation means on fallopian tube on ovarian response during controlled ovarian hyperstimulation(COH). Methods: A retrospective study was performed includ- ing 397 women treated with IVF-ET with unilateral/bilateral salpingectomy or salpingoplasty for ectopic pregnancy or salpingemphraxis and patients with tubal infertility with existing salpinx. A total of 116 women with history of unilateral (n=70, group A) or bilateral (n=46, group B) received salpingectomy; 60 women with history of unilateral (n=27, group C) or bilateral (n=33, group D) receivedv salpingoplasty. While the remaining women, who were accomplished in the same duration, with fallopian tube obstruction but without hydrosalpinges were acted as con- trol group (n=221, group E). The basic clinical information and ovarian response to gonadotropins were evaluated in these groups. Results : Compared with group E, baseline FSH level was significantly higher (P<0.05) but the number of follicles (15-20 mm) and oocytes retrieved were significantly lower in group B (P<0.05). Among the patients who had undergone unilateral salpingectomy, significantly fewer follicles developed and fewer oocytes were retrieved from the ovary on the operated side. Whereas different operation means on fallopian tube did not affect outcome for IVF treatment. Conclusion: Salpingectomy may reduce the ovarian response during ovulation. The operation may affect the blood supply to ovary so as to affect ovarian response to COH.