输卵管积水性不孕行新鲜胚胎移植的妊娠结局分析

目的：探讨输卵管积水性不孕患者采用体外受精－胚胎移植（ IVF-ET）助孕治疗并新鲜周期移植的特点和疗效。方法回顾性分析2010年1月至2015年12月因输卵管积水性不孕（实验组）于第四军医大学唐都医院生殖医学中心进行IVF-ET助孕治疗，长方案促排卵并新鲜周期移植的患者共564个周期；对照组为同期因单纯输卵管梗阻性不孕于第四军医大学唐都医院生殖医学中心进行IVF-ET治疗，长方案促排卵并新鲜周期移植的患者共2812个周期；比较两组的临床数据，包括：促性腺激素（ Gn）总量、Gn总天数、注射人绒毛膜促性腺激素（ hCG）日雌二醇（ E2）水平、卵裂率、受精率、可用胚胎率、种植率、临床妊娠率、周期取消移植率、卵巢过度刺激综合征（ OHSS）风险取消移植率；妊娠结局及新生儿结局，包括：异位妊娠率、自然流产率、早产率、多胎率、单胎足月儿体重、单胎足月体重儿比率、单胎足月巨大儿比率。结果输卵管积水组的种植率、临床妊娠率显著低于对照组（χ2值分别为16．31、9．06，均P＜0．05）；输卵管积水组的周期取消移植率、异位妊娠率显著高于对照组（χ2值分别为4．23、6．11，均P＜0．05）；两组的Gn总量、Gn总天数、hCG日E2水平、受精率、可用胚胎率、OHSS风险取消移植率、自然流产率、早产率、多胎率、单胎足月儿体重、单胎足月体重儿比率、单胎足月巨大儿比率，均无统计学差异（均P＞0．05）。结论输卵管积水性不孕采用IVF-ET助孕治疗并新鲜周期移植较单纯输卵管梗阻组的种植率、临床妊娠率更低，同时周期取消移植率、异位妊娠率更高；该研究暂未发现输卵管积水对新生儿的不良影响。

Pregnancy outcomes of fresh embryo transplantation in hydrosalpinx induced infertility patients

Objective To evaluate the characteristics and effects of fresh embryo transfer cycle and in vitro fertilization -embryo transfer ( IVF-ET ) on hydrosalpinx induced infertility patients .Methods Retrospective analysis was conducted on 564 cycles of hydrosalpinx induced infertility patients who were treated with IVF-ET, long-term ovulation protocol and fresh embryo transfer cycle in assisted reproduction center of Tangdu Hospital during January 2010 to December 2015.At the same period 2 812 cycles of tubal factor IVF-ET cases without hydrosalpinx accepting long-term ovulation protocol and fresh embryo transfer cycle were taken in control group .Two groups were compared in clinical characteristics including dosage of Gn , Gn duration, E2 level on HCG day, cleavage rate, fertilization rate, available embryo rate , implantation rate , clinical pregnancy rate , cycle cancellation rate , OHSS induced cancellation rate , pregnant outcomes and neonatal outcomes including ectopic pregnancy rate , spontaneous abortion rate , preterm birth rate , multiple pregnancy rate , weight of full-term singleton, rate of full-term singleton, rate of full-term macrosomia.Results The implantation rate and pregnancy rate in hydrosalpinx group were significantly lower than those in the control group (χ2 value was 16.31 and 9.06, respectively, both P<0.05), but cycle cancellation rate of transplantation and ectopic pregnancy rate were significantly higher (χ2 value was 4.23 and 6.11, respectively, both P<0.05).Two groups were not statistically different in dosage of Gn , duration of Gn application, E2 level on HCG day, fertilization rate, available embryo rate, OHSS induced cancellation rate, spontaneous abortion rate, preterm birth rate, multiple pregnancy rate, weight and rate of full-term singleton, and rate of full-term macrosomia (all P>0.05).Conclusion Transplantation rate and pregnancy rate are lower in hydrosalpinx induced infertility with treatment of IVF-ET and fresh embryo transfer cycle than in simple tubal factor infertility , and cycle cancellation rate and ectopic pregnancy rate are higher .The study does not show any adverse effect of hydrosalpinx on neonates .