输卵管积水对体外受精-胚胎移植(IVF-ET)的影响

<正>输卵管在人类生殖过程中执行多种功能:配子转运、受精、营养和胚胎发育.任何影响输卵管转运和分泌功能的因素都会影响正常受孕.输卵管积水引起的不孕约占不孕症的2.5～6%,以往治疗主要采用各种重建再通手术,但术后自然妊娠率低.1978年第一例试管婴儿诞生,人们开始更注重不依赖于输卵管通畅的助孕技术.然而,许多研究者逐渐发现输卵管积水会影响IVF结果.     

腹腔镜手术联合药物治疗未破裂输卵管妊娠160例分析

目的 :探讨腹腔镜手术联合药物治疗未破裂输卵管妊娠的临床疗效。方法 :采用腹腔镜下挤压法排出输卵管内妊娠物加甲氨蝶呤局部系膜下注射、配合口服米非司酮治疗 16 0例未破裂输卵管妊娠 ,术后行输卵管通液术检测输卵管通畅情况。结果 :16 0例手术均获成功 ,无中转开腹者 ,血β -HCG平均 14天下降至正常 ,输卵管通畅率达 96 .2 5 %。结论 :腹腔镜手术联合药物治疗未破裂输卵管妊娠比传统的开窗术更微创 ,治疗效果好 ,输卵管通畅率高 ,具有临床实用价值     

配子及胚胎输卵管内移植

<正>配子输卵管内移植(GIFT)或胚胎输卵管内移植(ETR)是治疗输卵管通畅的难治性不孕症的新方法,优点是比体外受精—胚胎移植(IVF-ET)更符合生理,无需IVF-ET中的体外受精卵培养或胚胎移植,而且妊娠率也比IVF-ET     

腹腔镜下输卵管吻合术的临床应用探讨

目的:评价腹腔镜下输卵管吻合术的临床应用价值.方法:对15例输卵管绝育术后或输卵管妊娠行保守性手术处理后输卵管断裂,因生育需要而要求复通者进行输卵管对端吻合术并随访妊娠率.结果:14例术后第1次月经干净后输卵管通液均显示通畅,术后1年半内复孕8例,受孕率57.1%.结论:腹腔镜下输卵管吻合术较开腹有一定优势,亦具有较高成功率,是输卵管堵塞患者的一个较好的治疗选择.     

腹腔镜与开腹手术治疗异位妊娠术后受孕率对比

目的:探讨腹腔镜保守性手术与开腹保守性手术治疗异位妊娠术后宫内受孕率的差异。方法:回顾性分析有生育要求的83例异位妊娠病例,其中行腹腔镜保守性手术43例,开腹保守性手术40例,术中配合患侧输卵管系膜处注射甲氨喋呤,比较两组手术术后输卵管通畅率和术后18个月内宫内受孕率。结果:腹腔镜组术后输卵管通畅率(88%)、宫内受孕率(61%)、再次异位妊娠率(7%);开腹组术后输卵管通畅率(73%)、宫内受孕率(48%)、再次异位妊娠率(8%)。结论:输卵管保守性手术后宫内妊娠率高,而再次异位妊娠率不增加,适合要求保留生育功能的年轻患者。     

输卵管宫腔植入术的动物实验研究

目的:探讨家兔输卵管宫腔植入术的可行性以及提高术后通畅率的方法。方法:以34只新西兰兔为研究对象,在显微器械辅助下分别对其行双侧输卵管宫腔植入术,术中使用硬脊膜外麻醉导管作为支架。以术中输卵管植入子宫壁的深度和术后是否留置支架为依据分成4组:无支架浅植入组(S组),无支架深植入组(D组),留置支架浅植入组(SS组)和留置支架深植入组(DS组)。术后7d取支架,28d剖腹探查,子宫输卵管通美蓝液了解输卵管通畅情况。结果:4组共有66条输卵管植入子宫,S组、D组、SS组、DS组的通畅率分别为5.9%、37.5%、68.6%、88.2%。深植入者(D组+DS组)输卵管术后通畅率(63.6%)高于浅植入者(S组+SS组)(36.4%),留置支架者(SS组+DS组)(78.8%)高于未留支架者(S组+D组)(21.2%)。结论:术中引导输卵管完全进入宫腔及术后输卵管内留置支架可提高术后输卵管通畅率。     

腹腔镜联合宫腔镜诊治输卵管性不孕52例分析

目的探讨应用宫、腹腔镜对输卵管性不孕的诊断价值及治疗效果.方法对52例经子宫输卵管碘油造影(HSG)诊断为输卵管性不孕的患者,单用腹腔镜下子宫导管内加压注入美蓝液检查证实双侧输卵管通畅者8例,一侧通畅者4例,双侧因各不同部位梗阻而不通者40例.对双侧及一侧不通的44例患者,根据不同部位病变进行治疗,如盆腔粘连松解,伞端扩张、造口及宫腔镜下输卵管间质部插管加压通液,开腹显微外科输卵管吻合、宫角植入等.结果52例输卵管性不孕患者中,双侧榆卵管通畅40例(77%),单侧通畅10例(19%),完全不通2例(3.9%).结论应用宫、腹腔镜联合检查、治疗输卵管性不孕,可避免单独使用宫腔镜、腹腔镜或开腹整形的局限性,提高诊断的准确性及治疗效果.     

宫、腹腔镜联合诊治输卵管性不孕症111例分析

目的:探讨宫、腹腔镜联合手术在输卵管性不孕症诊治中的临床价值。方法:应用宫、腹腔镜联合手术诊治111例输卵管性不孕患者,分析输卵管性不孕的主要原因和治疗效果。结果:111例中双侧输卵管阻塞35例(31.5%),单侧输卵管阻塞合并盆腔粘连18例(16.2%),双侧输卵管积水合并伞端闭锁58例(52.3%)。经治疗后50例双侧输卵管通畅(45.1%);39例一侧通畅(35.1%)。至今,共妊娠50例(45.1%)。结论:宫、腹腔镜联合手术是女性不孕症诊治的重要手段,治疗输卵管性不孕,特别是近端阻塞者再通率高、创伤小、疗效肯定,值得推广应用。     

输卵管造影和插管术在输卵管手术中的应用

目的:在妇科输卵管手术中采用非血管介入手术-输卵管造影和输卵管插管术放入支架,以提高术后输卵管的通畅率及术后妊娠率.方法:回顾性分析61例输卵管整形手术患者,31例观察组术中应用输卵管造影和插管技术,在输卵管狭窄处或端端吻合处放置微导管作为支 架,头端置于腹腔或输卵管腔,尾端置于宫腔内,术后1～2月后月经来潮时取出;30例对照组自输卵管伞端至宫角放置支架,尾端固定于腹壁切口,术后3～4天取出.观察、随访两组术后输卵管通畅率和妊娠率.结果:观察组31例共59条输卵管中,术后3个月53条输卵管通畅,占89.83%,2年内19例妊娠,占61.29%;对照组30例共58条输卵管,术后3个月27条通畅,占46.6%,2年内9例妊娠,占30%.两组对比,观察组术后输卵管通畅数、两年妊娠数明显高于对照组(P＜0.001、P＜0.01).结论:在输卵管整形手术中应用输卵管造影和输卵管插管,置入输卵管支架至创面愈合后取出,明显提高了术后输卵管的通畅率及再妊娠率,为输卵管再通提供了一种新的有效的治疗方法.     

输卵管性不孕的介入治疗及效果评价

输卵管具有拾卵功能,输卵管内完成配子运送、成熟、受精以及胚胎早期发育。输卵管性不孕是指各种因素导致输卵管管腔的蠕动能力减退、拾卵及将受精卵运送到宫腔的三大功能丧失。近年来,随着性传播疾病发生率的上升以及宫腔操作增加等,本病的发     

经阴道四维子宫输卵管超声造影评估不孕症患者输卵管通畅程度及形态的意义

目的 探究经阴道四维子宫输卵管超声造影评估不孕症患者输卵管通畅程度及形态.方法 选取100例不孕症患者,采用经阴道四维子宫输卵管超声造影、宫腹腔镜联合进行检查,观察不同检查方式检查输卵管的通畅程度及形态情况.结果 经阴道四维子宫输卵管超声造影临床诊断为输卵管阻塞准确率为92.11％,通畅准确率为94.12％,通而不畅准...     

Pregnancy after gamete intrafallopian transfer in a woman with primary infertility and in utero exposure to diethylstilbestrol. A case report

In utero exposure to diethylstilbestrol (DES) has an adverse effect on reproductive performance and may be associated with infertility. Gamete intrafallopian transfer (GIFT) is a new reproductive technique that has been advocated as an alternative to in vitro fertilization in women with at least one normally functioning fallopian tube. The process involves the translaparoscopic placement of oocytes and sperm into the fallopian tube. The technique has been successful in treating infertility due to endometriosis, male factors and immunologic factors as well as unexplained infertility. We accomplished the first successful GIFT procedure in a woman with significant uterine effects from prenatal DES exposure. This technique may prove to be an effective treatment for infertile women with DES exposure who have no adequate explanation for their infertility.     

Gamete intrafallopian transfer in a woman with tubal occlusion. A case report

Gamete intrafallopian transfer (GIFT) is usually performed when at least one fallopian tube is normally patent. We used GIFT in a case of bilateral tubal occlusion. The patient, who had primary ovarian failure, was enrolled in our GIFT program since it was assumed that her tubes were normally patent. Unexpectedly, at laparoscopy both tubes turned out to be distally occluded; nevertheless, GIFT was carried out by piercing the tubal wall. At this writing the patient had reached the 11th week of a normal intrauterine gestation and was still undergoing hormone replacement therapy.     

Hysteroscopy for gamete intrafallopian transfer (GIFT)

Gamete intrafallopian transfer (GIFT) is performed currently using laparoscopy. We report on a pilot-study from 1.1.1987 to 31.12.1987 and from 1.5.1988 to 30.4.1989, in which we used hysteroscopy instead of laparoscopy for the GIFT-procedure. The entering conditions were: unexplained (idiopathic) infertility, failure of previous treatments, proven fertilization capability of the gametes in at least one IVF attempt, and request of the married couple to dispense with laparoscopy during GIFT procedure. Hysteroscopic GIFT was initially performed on hysterectomy specimens, using the Chorionoskop. Continuous flow CO2 through the fallopian tubes did not result in loss of gametes. Twenty-four treatment cycles were performed in 16 patients. In 19 cycles, gametes were transferred into one tube, and in two cycles they were transferred into both tubes. Four of 16 women conceived: one patient delivered at term, three pregnancies ended in a first trimester abortion. These results demonstrate that the hysteroscopic approach to intrafallopian gamete transfer can be successful. However, the technique is demanding and requires extensive training. We conclude that further improvements of hysteroscopic GIFT are needed.     

Preliminary experiences with gamete intrafallopian transfer (GIFT)

This article describes the first series of patients to undergo gamete intrafallopian transfer (GIFT) as a treatment for infertility. Ten patients with the diagnosis of either unexplained infertility or male factor were treated with human menopausal gonadotropin and human chorionic gonadotropin before surgery by laparoscopy or minilaparotomy. Semen was collected 2.5 hours before oocyte pickup at surgery and treated by the technique of wash and swim-up. After gamete evaluation, one or two oocytes and 100,000 actively motile sperm were loaded into a catheter and introduced through the fimbria. The contents of the catheter were gently emptied at a site approximately 1.5 cm inside each fallopian tube. Patients received progesterone in oil, 12.5 mg/day, from day 4 after GIFT until up to 8 weeks of gestation. Four patients became pregnant: two pregnancies aborted; the other two pregnancies proceeded to the delivery of viable infants. GIFT may be considered as an alternative to in vitro fertilization in infertility cases in which at least one fallopian tube is patent.     

宫-腹腔镜联合输卵管复通术再通输卵管的效果评价

目的：评价宫-腹腔镜联合输卵管复通术的术后输卵管复通率及输卵管不同部位的复通率。方法：对2008年1月—2009年12月880例不孕症患者共1 760条输卵管进行宫-腹腔镜联合输卵管复通术,观察其术后的输卵管复通率。结果：宫-腹腔镜联合输卵管复通术的复通率为74.5%。其中,间质部为65.8%,峡部为56.5%,壶腹部为36.7%,伞端为86.0%。术后随访2年自然妊娠率39.6%。结论：输卵管伞端复通率最高,间质部次之,壶腹部复通率最低。     

三种助孕技术治疗多囊卵巢综合征不孕的疗效比较

目的：观察３种助孕技术：ＩＶＦ ＥＴ、ＧＩＦＴ和控制性超促排卵（ＣＯＨ）后自行同房对多囊卵巢综合征（ＰＣＯＳ）不孕患者的疗效。方法：应用３种方法治疗,观察各组的临床妊娠率和发生卵巢过度刺激综合征（ＯＨＳＳ）的情况。结果：ＩＶＦ ＥＴ和ＧＩＦＴ与ＣＯＨ相比能得到更高的临床妊娠率,而前二者发生ＯＨＳＳ的危险性明显低于后者。结论：为避免ＣＯＨ后发生ＯＨＳＳ,建议对因ＰＣＯＳ不孕的患者采取体外助孕技术治疗。应用何种技术要根据患者的具体情况而定。如果有至少１ 条输卵管完全正常,可先试行ＧＩＦＴ。此外,须将多余的卵子进行体外授精试验,观察其受精及卵裂情况,从而对今后的治疗提出指导性建议,并要将得到的胚胎进行冷冻保存,以备今后使用。     

Infertility and chlamydial infection

The prevalence of humoral IgG and IgM antibodies to Chlamydia trachomatis was determined in 105 infertile women who underwent laparoscopy and/or laparatomy, and 90 pregnant women without any known fertility problems (control group). For chlamydial culture, cervical and urethral specimens were collected both from the infertile and the pregnant women, whereas specimens from the fallopian tubes were collected from the infertile women only. Among infertile subjects with abnormal fallopian tube findings, the prevalence of IgG as well as IgM antibodies to C. trachomatis was significantly higher than in the control group (P less than or equal to 0.001). Similar statistically significant differences in antichlamydial geometric mean titer (GMT) also were observed in sera from infertile subjects with fallopian tube abnormalities and the controls. The chlamydial isolation rate from lower genital samples was low both among the infertile and pregnant women. All tubal samples were culture negative. The present study indicates a close connection between infertility of tubal etiology and an immune response to C. trachomatis. The possibility of active or recent chlamydial activity in at least some of these infertile subjects is discussed.     

Investigation of the uterine cavity and fallopian tubes using three-dimensional saline sonohysterosalpingography.

OBJECTIVE: To compare three-dimensional saline sonohysterosalpingography (SHSG) to X-ray hysterosalpingography (HSG) for the evaluation of the uterine cavity and fallopian tubes. PATIENT POPULATION: Fifteen infertile women on whom X-ray HSG had been performed within 1 year prior to this study. METHOD: Fifteen infertile women underwent three-dimensional power Doppler examination of the uterus and fallopian tubes with three-dimensional SHSG during the follicular phase. Distension was achieved using sterile saline injected through a 5 French HSG catheter. Peritoneal accumulation of free fluid surrounding the ovary and tube was required for a diagnosis of a patent tube. Fluid accumulation in the cul-de-sac without visualization of the tubes was considered consistent with at least one tube being patent. RESULTS: three-dimensional saline SHSG was completed in 14 patients. One patient had cervical stenosis and the procedure could not be performed. No significant intrauterine pathology was identified by either X-ray HSG or sonography. Three-dimensional saline SHSG made false positive diagnoses of tubal occlusion in four out of seven fallopian tubes (57%). The sensitivity and specificity for detecting tubal occlusion was 75 and 83%, respectively, with a positive predictive value of 40% and negative predictive value of 95%. Detection of fallopian tube architecture was not possible with three-dimensional saline SHSG in any patient. Simultaneous use of three-dimensional Doppler did not clearly identify the flow of saline through the fallopian tubes. CONCLUSIONS: Transvaginal three-dimensional saline SHSG provides good visualization of the uterine cavity and myometrial walls in three orthogonal planes. However, it does not diagnose tubal occlusion or depict architecture of the fallopian tube as accurately as X-ray HSG. Although we were able to visualize the distal fallopian tube and fimbria with real-time imaging, we were not able to satisfactorily image the proximal tube with three-dimensional power Doppler. This technique may be reserved as an initial screening test to evaluate the uterine cavity and test patency. Patients at high risk for tubal disease by history or with suspected tubal occlusion on three-dimensional saline SHSG should be evaluated by either X-ray HSG or laparoscopy with chromopertubation. Further improvements of three-dimensional technology and contrast materials will, it is hoped, make this method comparable to X-ray HSG.     

In vivo fertilization procedures in infertile women with patent fallopian tubes: A comparison of gamete intrafallopian transfer,combined intrauterine and intraperitoneal insemination,and controlled ovarian hyperstimulation alone

This prospective study was undertaken to evaluate the relative efficacy of three in vivo methods of assisted fertilization in 150 infertile women with patent fallopian tubes: gamete intrafallopian transfer (GIFT), combined intrauterine and direct intraperitoneal insemination (IUI + DIPI), and controlled hyperstimulation (COHS) alone. The clinical pregnancy rate was highest in the IUI/DIPI and GIFT groups: IUI/DIPI, 29.3%; GIFT, 28.6%; and COHS, 8.9%. We believe that controlled ovarian hyperstimulation combined with IUI and DIPI is a good alternative to GIFT.