体外受精-胚胎移植(IVF-ET)输卵管积水预处理后冻融胚胎解冻移植结局分析

目的:探讨体外受精-胚胎移植(IVF-ET)中输卵管积水患者积水处理(单侧或双侧输卵管切除/结扎)后冻融胚胎移植结局和影响因素。方法:回顾分析2012年6月~2014年6月在兰州大学第一医院生殖医学专科医院因输卵管积水行IVF-ET的117例患者的临床资料。117例患者中,取卵后因积水返流宫腔行全胚冷冻取消移植者69例,不良结局者48例。比较行输卵管积水处理后的117例患者(研究组)和因输卵管因素行冻融胚胎解冻移植(FET)的212例患者的妊娠结局。结果:研究组117例患者中111例行积水单侧或双侧结扎/切除,6例行输卵管栓塞,FET 115例后妊娠70例,妊娠率60.87%,早期流产8例,流产率11.42%,宫角妊娠2例。对照组212例完成206个解冻移植周期,妊娠114例,妊娠率55.33%,早期流产12例,早期流产率10.52%,异位妊娠3例,异位妊娠率2.63%。两组的受精率、可利用胚胎率、临床妊娠率等无统计学差异(P0.05)。结论:体外受精-胚胎移植(IVF-ET)取卵后输卵管积水切除或结扎或栓塞后行冻融胚胎解冻移植,可获得良好的妊娠结局。     

输卵管积水抽吸术在体外受精-胚胎移植中的意义

目的:评价输卵管积水抽吸术在输卵管积水患者行体外受精-胚胎移植(IVF-ET)中的意义。方法:回顾性分析2005年1月~2009年12月在广州医学院第三附属医院生殖中心因输卵管因素不孕症行IVF-ET治疗的患者资料1029例(1190个周期),分为输卵管积水抽吸组(A组)75例(88个周期)、输卵管积水组(B组)49例(60个周期)和双侧输卵管阻塞组(C组)905例(1042个周期)。结果:3组患者Gn总量、超排天数、移植胚胎数、冷冻胚胎数差异均无统计学意义(P>0.05)。3组间受精率、胚胎种植率、移植取消率、临床妊娠率、多胎妊娠率、中晚期流产率、异位妊娠率差异均无统计学意义(P>0.0167)。A、B两组HCG日直径>12mm的卵泡数、获卵数均少于C组(P<0.05),A、B两组差异无统计学意义(P>0.05);A组生化妊娠率、早期流产率高于C组(P<0.0167),B、C组差异无统计学意义(P>0.0167)。结论:取卵时经阴道输卵管积水抽吸术没有改变输卵管积水患者临床妊娠率低、早期流产率高的结局。     

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。     

超声晶氧介入治疗输卵管性不孕症198例临床研究

目的:评价超声晶氧(CPP)输卵管显像介入治疗输卵管性不孕症的结局。方法:对确诊为输卵管性不孕症患者随机分组,治疗组198例采用超声晶氧进行子宫输卵管声学造影治疗;对照组180例采用输卵管通液术。结果:治疗组198例中,一次晶氧治疗后52例双侧输卵管通畅。对于双侧或单侧输卵管梗阻患者或输卵管通而不畅患者再进行第2次或第3次的晶氧治疗,术后随访3.5年。93例妊娠并分娩,3例异位妊娠,7例流产。治疗组妊娠率及总有效率均高于对照组。结论:超声晶氧输卵管显像介入治疗输卵管性不孕,其疏通输卵管的作用明显,临床效果显著,应用方便。     

影响输卵管积水患者腹腔镜术后妊娠率的相关因素分析

目的:研究输卵管积水患者腹腔镜术后影响其自然妊娠率的高危因素,为患者个体化治疗提供临床依据。方法:回顾性分析我院2010年1月至2013年12月因输卵管积水行腹腔镜手术患者643例的临床资料,并对影响其自然妊娠率的因素进行单因素及多因素Logistic回归分析。结果:643例患者临床妊娠率为34.06%(219/643),正常宫内妊娠率为21.15%(136/643),流产率为3.89%(25/643),异位妊娠率为9.02%(58/643)。单因素分析结果显示,输卵管积水患者腹腔镜术后自然妊娠率与年龄、不孕年限、是否有盆腹腔手术史及盆腔输卵管病变程度有关(P0.1),与不孕类型、体质量指数、是否有异位妊娠史、单侧或双侧积水、主刀医师不同无关(P0.1);多因素分析显示,不孕年限5年(OR=1.539,P=0.008)和盆腔输卵管中、重度病变(OR=1.569,P=0.001)是输卵管积水患者腹腔镜术后影响其妊娠能力的独立危险因素。结论:在指导输卵管积水患者腹腔镜术后适时妊娠方面,应充分考虑患者的不孕年限和输卵管病变程度,实现个体化治疗,有望提高妊娠率。     

输卵管再通术对近端输卵管阻塞不孕症临床治疗结局的影响

目的:探讨输卵管再通术(FTR)治疗近端输卵管阻塞(PTO)不孕症后受孕方式的选择及影响术后妊娠率的相关因素。方法:回顾分析2019年7月至2021年12月在西安交通大学第二附属医院行FTR后双侧输卵管通畅的93例患者的临床资料。根据自主选择受孕方式不同分为观察组(32例)及对照组(61例),观察组采取促排卵周期的宫腔内人工授精(IUI)助孕,对照组采取自然受孕,比较两组的妊娠率及妊娠结局。按照受孕后妊娠情况分为妊娠组(56例)和非妊娠组(37例),采用多因素logistic回归分析影响患者术后妊娠率的危险因素。结果:两种受孕方式的妊娠率和妊娠结局比较,差异均无统计学意义(P>0.05)。术后1～6月的妊娠率均高于术后7～12月(P<0.05);受孕时间在术后7～12月时,促排卵周期IUI的妊娠率明显高于自然受孕(P<0.05),受孕时间在术后1～6月时,两者的妊娠率无显著差异(P>0.05)。女性年龄、输卵管阻塞程度、AMH是影响FTR术后妊娠率的独立危险因素(P<0.05)。结论:输卵管再通术后前半年的妊娠率高于后半年,半年后自然受孕的妊娠率低于促排卵...     

输卵管妊娠不同方法治疗后再次妊娠的探讨

目的:探讨输卵管妊娠用不同方法治疗后再次妊娠的情况。方法:随访562例输卵管妊娠后患者,分析影响治疗选择的因素;用生存曲线方法及多因素COX回归分析其中100例有生育要求患者治疗后宫内自然妊娠率和再次异位妊娠率。结果:100例中行输卵管根治术44例,保守性手术28例,药物保守治疗28例。24个月累积重复异位妊娠发生率分别为6.9%,13.7%,0.04%,差异有统计学意义(P<0.005);累积自然宫内妊娠率分别为31.8%,34.4%,65.3%,用COX回归排除影响治疗选择因素,得出年龄≤30岁,无影响输卵管功能高危因素的患者,药物保守治疗后宫内妊娠率最高,保守性手术次之,根治性手术最低;年龄>30岁,存在影响输卵管功能的因素,3种方法治疗后宫内妊娠率差异无统计学意义。结论:为提高年轻输卵管妊娠患者治疗后的宫内妊娠率,应尽量行药物保守治疗。     

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。     

不同输卵管手术方式对体外受精-胚胎移植治疗结局的影响

目的:探讨体外受精-胚胎移植(IVF-ET)中不同的输卵管手术方式对治疗结局的影响。方法:回顾性分析长方案超促排卵IVF周期378例输卵管因素不孕患者:双侧输卵管切除58例(A组);双侧输卵管造口45例(B组);双侧输卵管近端结扎+远端造口37例(C组);单侧输卵管整形42例(D组);单侧输卵管切除45例(E组);随机选取单纯双侧输卵管梗阻无积水患者151例作为对照组(F组);比较患者的一般情况、卵巢对促排卵的反应性和临床治疗结局。结果:①基础窦卵泡(bAFC)数、Gn使用总量、Gn用药时间、hCG注射日卵泡数目、获卵数及冷冻胚胎数,A组较其他手术组及对照组差异均有统计学意义(P<0.05);其他手术组与对照组比较,差异无统计学意义(P>0.05)。各组间受精率、优质胚胎率和移植胚胎数均无统计学差异(P>0.05)。B组妊娠率和种植率显著低于其他各组,而异位妊娠率和流产率显著高于其他各组(P<0.05)。②E组患侧(手术侧)hCG注射日卵巢体积(OVVOL)、卵泡数(直径≥15 mm)和获卵数明显少于健侧卵巢(P<0.05),而D组患侧与健侧上述指标差异无统计学意义(P>0.05)。结论:双侧输卵管切除术增大了促排卵Gn用量和使用天数,减少了获卵数;但不影响受精率、优质胚胎率及着床率,因而不影响IVF-ET单次临床妊娠率。单侧手术由于健侧输卵管的代偿作用对IVF治疗无明显影响。造口术再次发生输卵管积水风险升高,种植率、妊娠率下降,异位妊娠率和流产率升高。     

薄壁及厚壁输卵管积水整形术后妊娠结局和复发情况比较研究

目的探讨薄壁及厚壁输卵管积水患者在腹腔镜下行新型输卵管整形术后妊娠结局及复发情况的差异。方法严格按照入组标准,选择北京大学人民医院2003年1月至2009年11月因输卵管积水腹腔镜下行新型整形术的不孕患者201例,依据Brosens,Ivo方法将患者分为薄壁输卵管积水组123例和厚壁组78例,观察术后两组间妊娠结局及输卵管积水复发情况的差异。结果两组间患者年龄比较差异无统计学意义(P0.05);术后薄壁组总妊娠率、自然妊娠率、体外受精(IVF)妊娠率分别为47.97%、47.32%、54.55%,均高于厚壁组17.95%、16.98%、20.00%,两组间比较差异有统计学意义(P0.05)。其中自然妊娠中宫内妊娠率两组间比较差异有统计学意义(P0.05),薄壁组为37.50%高于厚壁组7.55%;异位妊娠率比较差异无统计学意义(P0.05),术后7~8个月自然妊娠率最高。薄壁积水合并盆腔粘连发生率(72.36%)低于厚壁积水组(96.15%),两组间比较差异有统计学意义(P0.05);复发率两组间比较差异有统计学意义(P0.05),薄壁组(6.50%)明显低于厚壁组(21.79%)。结论薄壁输卵管积水患者整形术后的妊娠率明显优于厚壁积水患者。在临床治疗中对输卵管积水进行分类,对薄壁输卵管积水患者腹腔镜下行输卵管整形术术后可得到较满意的妊娠结局,而对于厚壁输卵管积水患者行整形术后妊娠结局较差,建议酌情行输卵管近端结扎或切除术。     

Cure of female sterility. Treatment of hydrosalpinx

BACKGROUND: The aim of this study was to show how a laparoscopic salpingectomy can positively modify infertile patients pregnancy rate after a diagnosis of hydrosalpinx, obtaining, through successive assisted procreation programs, a pregnancy rate equal to the pregnancy rate obtained in good conditions. METHODS: A group of 19 women under infertility treatment was evaluated: of these women, 11 were included less than three times in an assisted procreation program and 8 were included three or more times in these programs, for a total of 41 cycles of assisted reproduction: all these cycles were characterized by a negative result. All 19 patients were treated by diagnostic-operative laparoscopy: a salpingectomy was carried out after a hydrosalpinx in all these cases. RESULTS: All patients were treated with 2 assisted reproduction cycles, which were made with a variable range of time from 3 to 6 months after laparoscopic surgery, totalizing 38 cycles. At present, 4 pregnancies have been obtained (pregnancy rate = 22%): this value is comparable to the values obtained in the best assisted reproduction programs. CONCLUSIONS: Many studies showed that hydrosglpinx presence reduces very much FIVET procedures. There are many cases showing that the hydrosalpinx become worse, if it has not been preventively treated, during assisted reproduction programs. Moreover complications during FIVET programs in the presence of hydrosalpinx are observed. Even if this study is based on data related to a small number of patients, it's clear that surgical treatment of severe tubarian pathology can give the best results where an assisted reproduction program will be surely unsuccessful.     

Polycystic ovary syndrome treated with laparoscopic ovarian drilling with a harmonic scalpel. A prospective,randomized study

OBJECTIVE: To evaluate the endocrinologic profile and reproductive outcome after laparoscopic drilling using a harmonic scalpel for polycystic ovarian syndrome (PCOS) in clomiphene-resistant infertile women. STUDY DESIGN: We performed a prospective, randomized study of 34 infertile women with PCOS. Group A (17 women) underwent laparoscopic ovarian drilling using a harmonic scalpel laser. Group B (control group, 17 women) underwent laparoscopic ovarian drilling using a neodymium-yttrium-aluminum-garnet laser. Change in the hormonal profile after surgery, ovulation rate and pregnancy rate were compared between groups A and B. RESULTS: LH and testosterone serum levels and the LH-FSH ratio showed a statistically significant reduction after surgery, and the spontaneous ovulation rate was 94% in both groups. The cumulative pregnancy rates within two years of follow-up were 77% in group A and 60% in group B. CONCLUSION: Laparoscopic ovarian drilling using a harmonic scalpel is an effective treatment for PCOS in clomiphene-resistant, anovulatory women: it results in ovulation and conception without major complications.     

介入性输卵管栓塞术对体外受精-胚胎移植结局的影响

目的探讨介入性输卵管栓塞术对输卵管积水患者行体外受精-胚胎移植(IVF-ET)治疗结局的影响。方法对2009年5月至2010年5月因输卵管性不孕于盛京医院辅助生殖中心行IVF-ET200例临床资料进行回顾性分析。分为3组。A组:输卵管阻塞,无积水(92例);B组:有输卵管积水,经腹腔镜行输卵管切除术或造口术(31例);C组:有输卵管积水,行介入性输卵管栓塞术(77例)。结果各组间临床妊娠率差异无统计学意义(P>0.05)。介入治疗组获卵数略高于腹腔镜治疗组。结论介入性输卵管栓塞术是一种值得推荐的IVF-ET前输卵管积水的治疗方法。     

Hydrosalpinx and infertility: what about conservative surgical management?

Objective

The aim of this study was to assess and validate a management protocol for infertile patients affected by at least one hydrosalpinx.

Study design

Eighty-one consecutive infertile normo-ovulatory patients with uni or bilateral hydrosalpinx planed to be surgically managed were included in the protocol from November 2003 to May 2007. During laparoscopy, a systematic evaluation of the tubes was firstly conducted and the local management protocol based on validated tubal prognostic scores was applied. Surgery for hydrosalpinx was either conservative by neosalpingostomy or radical by salpingectomy. The primary end-point was the cumulative clinical pregnancy rate.

Results

115 hydrosalpinges out of 153 present tubes were confirmed during laparoscopy. Neosalpingostomy was possible in 35 patients featuring 50 hydrosalpinges (43.2% and 43.5%, respectively). Salpingectomy was necessary for the others (46 patients representing 65 hydrosalpinges). The mean follow-up period was 31.8 ± 12.4 months. The overall cumulative pregnancy rate was 61% per couple who completed the protocol (33/54 patients). The cumulative pregnancy rate was 50% after IVF in patients who underwent bilateral salpingectomy. Among patients with at least one functional tube, the overall cumulative pregnancy rate was 63.3%, with a spontaneous pregnancy rate of 30.4%.

Conclusion

Hydrosalpinx management can be conservative with a tubal conservative of 43.5% and fair chances for spontaneous conception. An integrated management of hydrosalpinx including ART actually leads to a cumulative pregnancy rate of 61% per patient.     

Impaired implantation after in vitro fertilisation treatment associated with hydrosalpinx

Objective To study whether the presence of hydrosalpinx affected success after in vitro fertilisation (IVF) in women with inflammatory tubal damage.
Design Retrospective, nonrandomised study.
Setting University private IVF clinic with complete fertility services.
Participants Two study groups (79 women with hydrosalpinges and 198 women with inflammatory tubal damage but no hydrosalpinx) and a third group (22 sterilised, previously fertile women) for comparison.
Main outcome measures Clinical pregnancy and livebirth rates per embryo transfer cycle; implantation and live baby rates per individual embryo transferred.
Results The hydrosalpinx group had a significantly lower implantation rate per embryo (8.2%) and chance of a live baby per embryo transferred (5.6%), compared with the nonhydrosalpinx group (14.9% and 11.2%, respectively). The hydrosalpinx group also had a lower clinical pregnancy rate (23%) and live birth rate per transfer cycle (17%) compared with the nonhydrosalpinx group (30% and 26%), but these differences were not significant.
Conclusions The presence of a hydrosalpinx halves the chance of an embryo implanting, probably due to physical or toxic chemical effects of fluid draining from the hydrosalpinx into the uterine cavity. Women with hydrosalpinges may benefit from distal salpingostomy or salpingectomy as a drainage procedure before in vitro fertilisation treatment, even though such surgery may not increase the chances of natural conception.     

Nd:YAG laser therapy for infertility with a contact-type probe

Laparoscopic Nd:YAG laser surgery for tubal adhesiolysis, hydrosalpinx and other disorders is an effective treatment for female infertility that causes relatively little tissue damage. In initial studies using contact-type probes, the 0.4-mm-diameter probe and 10 mm/sec incision speed were found to cause less tissue degeneration than did other combinations (P less than .05). Fifteen infertile women were treated at laparoscopy with a Nd:YAG laser; one of six with hydrosalpinx achieved pregnancy after salpingostomy using a contact-type probe, two of three with tubal adhesions achieved pregnancy after adhesiolysis with the Nd:YAG laser, and three of six with polycystic ovaries achieved pregnancy after wedge resection using a contact-type probe. Five of fifteen infertile women conceived after Nd:YAG laser surgery with a contact-type probe under laparoscopy. We confirmed that contact irradiation with a ceramic incising probe is capable of creating an adequate incision at low power levels and that laparoscopic Nd:YAG laser surgery for infertile women is an effective treatment.     

177例不孕症患者宫腔镜下子宫内膜息肉摘除术的临床疗效分析

目的:探讨宫腔镜下子宫内膜息肉摘除术对不孕患者生育功能的改善和治疗效果。方法:对177例子宫内膜息肉(endometrial polyp,EP)的不孕患者(研究组)行宫腔镜下内膜息肉摘除结合刮宫术,术后追踪观察EP复发情况,并与374例同期行宫腔镜检查提示宫腔正常的不孕患者(对照组)进行术后妊娠情况的比较。结果:术后妊娠率研究组(25.99%,46/177)与对照组(29.14%,109/374)无差异,术后平均获得妊娠时间研究组为4.8±3.8个月,对照组为5.0±3.9个月,组间也无统计学差别(P>0.05)。研究组中131例EP患者未妊娠,另76例于术后1￣36个月进行了第二次宫腔镜检查:结果宫腔正常53例,EP复发23例。结论:子宫内膜息肉是引起不孕症的主要宫腔病因之一,宫腔镜下子宫内膜息肉摘除术可去除病因,使患者获得妊娠。     

A reassessment of comparative pregnancy and implantation rates following embryo transfer in recipients vs their infertile donors also trying to conceive in the background of performing salpingectomy for hydrosalpinx

PURPOSE: To compare pregnancy and implantation rates in egg donors trying to conceive vs their recipients in the background of salpingectomy for hydrosalpinx prior to IVF-ET. METHODS: A retrospective six-year review of all donor egg cycles where the eggs are supplied by an infertile donor trying to conceive herself was carried out. Salpingectomy for hydrosalpinx was performed prior to IVF-ET. RESULTS: Clinical and delivered pregnancy rates (PRs) following fresh ET were not significantly different in donors vs recipients (60.0%, 45.8% vs 56.8%, 50.8%). Implantation rates were 27.3% vs 32.6%. The respective implantation rates following frozen ET were 13.8% and 14.4%. CONCLUSIONS: In the background of salpingectomy for hydrosalpinges the much higher PRs in recipients vs donors is no longer seen. The trend for higher implantation rates in recipients (about 20%) following fresh but not frozen transfer could still reflect some adverse effect of the controlled ovarian hyperstimulation regimen in a minority of women.     

输卵管积水对人早期胚胎体外发育的影响

目的:探讨人输卵管积水(HSF)对人早期胚胎体外发育的影响。方法:因输卵管积水、阻塞行IVF/ICSI-ET患者取卯时穿刺抽吸HSF30例,送细菌培养及成分分析等。同期收集161例行IVF/ICSI-ET患者受精第1日的261枚异常受精卵(1PN,≥3PN),随机分成3组,分别培养于含不同体积分数的HSF培养液中:A组(50%HSF,n=91)、B组(100%HSF,n=89)和C组(对照组,0%HSF,n=81),观察胚胎发育情况,计算卵裂率、优质胚胎率、囊胚形成及孵出率、优质囊胚率等。结果:4例HSF细菌培养阳性(13.33%);HSF中总蛋白及葡萄糖显著低于该患者同目的血清水平。与C组比,未放入卵子的A、B组培养液平衡后,pH值升高,B组渗透压降低(P<0.05)。3组卵裂率、优质胚胎率无统计学差异(P>0.05);囊胚形成率及优质囊胚率A组(15.38%,21.43%)、B组(11.24%,10%)明显低于C组(28.40%,82.61%)(P<0.05)。结论:HSF影响人囊胚形成及囊胚质量,可能与HSF中低葡萄糖、低蛋白、低渗透压、高pH有关,自然状态下可能还与存在一定比例的细菌有关。     

宫颈糜烂不孕患者应用射频自凝刀治疗术后宫颈黏液和妊娠率的改善

目的:探讨宫颈糜烂不孕患者应用射频自凝刀治疗后宫颈黏液和妊娠率的改变。方法:宫颈糜烂不孕患者62例,依其宫颈糜烂程度分为3组:轻度糜烂组(n=8)、中度糜烂组(n=38)、重度糜烂组(n=16)。应用射频自凝刀治疗术治疗,术前行宫颈黏液评分。治疗后随访1年,评价宫颈黏液和妊娠的情况。结果:射频自凝刀治疗总有效率为100%。轻度、中度、重度组的痊愈率分别为100%、94.7%和87.5%。62例患者治疗后宫颈黏液评分与治疗前的比较有显著提高(P<0.01),宫颈黏液性状明显改善。在随访期内,3例妊娠早期流产,9例在孕,4例分娩,妊娠率为21%。结论:射频自凝刀治疗术能改善宫颈糜烂不孕患者的宫颈黏液性状和妊娠率。