辅助生殖技术后发生宫内外同时妊娠的相关因素分析

目的探讨辅助生殖技术后发生宫内外同时妊娠的高危因素、诊断、治疗及预后。方法对2005年1月～2008年10在广州医学院第三附属医院生殖科进行辅助生殖治疗后发生的7例宫内外同时妊娠病例进行回顾性分析。结果宫内外妊娠的发生率为0.6%,5例为输卵管因素不孕,其中1例有既往异位妊娠史。6例经B超确诊,1例经手术确诊。1例行阴道B超引导下异位孕囊穿刺抽吸胚芽术,1例行输卵管切开取胚术,5例行输卵管切除术,其中3例在异位病灶去除后继续宫内妊娠并分娩活婴。结论既往输卵管盆腔疾病或手术、异位妊娠史是辅助生殖技术后发生宫内外同时妊娠的高危因素。对有高危因素的患者早期加强B超检测有助于早期诊断、早期治疗,将对宫内妊娠的影响减到最小。     

辅助生育技术与自然受孕双胎妊娠结局的临床分析

目的探讨辅助生育技术与自然受孕两种不同方式双胎妊娠的临床结局。方法回顾性分析我院2005年-2008年7月分娩的143例辅助生育技术受孕双胎孕妇（ART组）和108例自然受孕双胎孕妇（对照组）的孕期合并症、分娩方式及围产儿儿结局。结果（1）ART组孕妇平均年龄（33．1±4．0）岁,对照组为（28．2±4．0）岁,两组比较差异有极显著性（P〈0．001）。（2）不良孕产史发生率ART组高于对照组（13．7％vs3．7％）,差异有极显著性（P〈0．01）;初次产检孕周,ART组为（13．1±5．4）周,对照组为（17．4±6．9）周,ART组的孕期产检次数为（8．2±2．8）次,对照组为（6．7±3．1）,均有极显著性差异（P≤0．001）。（3）ART组分娩孕周为（35．1±2．1）周,对照组为（34．4±2．4）周,ART组34周及以上分娩率高于对照组（P〈0．05）;妊娠期高血压疾病的发生率ART组低于对照组。（4）ART组新生儿平均出生体重（2394．3±38．04）g,对照组为（2184．9±53．20）g,差异有极显著性（P=0．001）。ART组极低出生体重儿发生率低于对照组。新生儿窒息、围产儿死亡率、一胎胎死宫内、先天性畸形的发生率,两组均无显著差异。结论ART助孕双胎孕妇更加重视孕期保健,分娩孕周延长,妊娠期高血压疾病的发生率较低,ART助孕组单卵双胎的比例较低．围产儿结局与自然爱孕双胎相似．     

IVF-ET后宫内外同时妊娠不典型病例报告并文献复习

目的探讨体外受精一胚胎移植（invitrofertilization and embryo transfer,IVF—ET）后宫内外妊娠的不典型临床表现及防治方法。方法对在武汉大学人民医院生殖科进行助孕治疗后发生宫内外同时妊娠的2例病例进行回顾性分析。结果典型的宫内外同时妊娠（heterotopicpregnancy,HP）的临床表现既具有宫内妊娠的特点又具有异位妊娠的特点,其四联征为：腹痛、腹部包块、腹膜刺激症状和子宫增大,但本文中的两例病例均无上述典型表现,其中一例因先兆流产收住入院;另一例因卵巢过度刺激综合征（ovarianhyperstimulationsyndrome,OHSS）收住入院,两例均经腹腔镜探查确诊与治疗,治疗后宫内妊娠存活。结论IVF—ET带来的并发症较多,其中宫内外妊娠后果较为严重,尤其是症状不典型的宫内外同时妊娠患者易误诊从而导致严重后果,因此应加大对IVF—ET后妊娠患者宫内及附件等盆腔器官的监测,以便对疾病可以早发现、早诊断、早治疗,防治不良结果的发生。     

辅助生育技术后单卵双胎妊娠三例分析

多胎妊娠是辅助生育技术常见的并发症之一,多胎妊娠直接造成妊娠并发症和围生儿病死率上升,威胁到患者的身心健康和影响辅助生育技术的最后结局。辅助生育技术的多胎妊娠主要是多个胚胎移植引起的异卵多胎妊娠,但也有由同一受精卵分裂成单卵多胎现象发生。     

宫内外同时妊娠诊治二例报告

<正>宫内外同时妊娠(heterotopic pregnancy,HP)是指宫腔内妊娠和异位妊娠同时存在的一种妊娠并发症。随着促排卵技术及辅助生殖技术的发展,该病的发病率明显升高。现将我院2012年9月至2013年9月诊治的2例宫内外同时妊娠报告如下。1病例病例1:患者王某,女,26岁,2012年7月因"原发性不孕症,多囊卵巢综合征"外院行"LE+HMG+HCG"     

经阴道穿刺治疗宫内外同时妊娠4例

目的 探讨经阴道穿刺在宫内外同时妊娠(HP)治疗中的应用及价值.方法 2004年1月至2009年12月广州医学院第三附属医院生殖医学中心体外授精-胚胎移植(IVF-ET)妊娠患者中,筛选出经阴道穿刺治疗的4例HP患者,分析探讨经阴道穿刺治疗HP的适应证、时机的选择、治疗方法及妊娠结局.结果 经阴道穿刺治疗的4例HP均为宫内妊娠合并输卵管妊娠,4例患者宫内妊娠胚胎及异位妊娠胚胎均见原始心管搏动.3例行经阴道穿刺抽吸异位妊娠胚胎,其中2例治疗时间分别为孕42d、43 d,均足月分娩,1例治疗时间为孕68d,穿刺术后4 h输卵管破裂行开腹手术治疗,术后4d宫内妊娠流产.另1例抽吸胚胎后注射50%葡萄糖2 ml,治疗时间为孕50 d,足月分娩.结论 如果HP患者孕周较小(＜8周),病变输卵管未破裂,无明显的腹腔内出血,术后能够有较长时间定期复诊随访,则可以选择经阴道穿刺治疗HP.     

放置宫内节育器与异位妊娠关系的临床分析

放置IUD是我国计划生育的一项重要措施,对其是否增加异位妊娠的发病率争论不一。本文就我院1991年至1998年收治的放置IUD妇女异位妊娠56例进行分析,并与同期未放置IUD妇女异位妊娠进行对比分析如下。     

宫腔镜在162例流产后宫内妊娠组织残留的临床应用

目的：探讨宫腔镜诊治宫内妊娠组织残留的临床价值。方法回顾分析2013年6月~2014年6月宫腔镜检查+清宫术诊治流产后宫内组织残留患者162例,其中稽留流产98例、早期人工流产15例、中、晚期引产12例、药物流产37例,所有病例宫腔镜诊治前均行1~3次清宫术。结果①宫腔镜检查发现宫角部残留72例,不全中隔子宫5例,不同程度的宫腔粘连58例,其中12例合并宫颈管粘连,手术成功率97.53%,平均手术操作时间(15.45±6.21)min,平均出血量(10.96±3.255)ml。②术后随访1~3个月,4例术后40 d无月经来潮,并发症发生率2.47%,所有病例术后阴道流血平均(3.75±1.96)d。结论宫腔镜检查+清宫在诊治宫内妊娠组织残留较盲目性刮宫具有成功率高、手术操作时间短、出血量少等明显优势,值得在临床推广应用。     

胚胎移植(ET)后致输卵管妊娠一例分析

胚胎移植是近20年发展起来的一项辅助生育技术,这项技术为广大不育症夫妇带来了福音, 全世界已有30万名试管婴儿出生,我国已成功诞生试管婴儿达2000余例.ET有各种并发症发生,常见的有流产、多胎、遗传病,ET致异位妊娠也有报道.我们收治一例类似病例,现报道如下.     

Increased pregnancy failure rates after clomiphene following assisted reproductive technology.

The obstetric outcome of 1941 in-vitro fertilization (IVF) and 1436 gamete intra-Fallopian transfer (GIFT) pregnancies reported from 25 units in Australia and New Zealand have been reviewed. Recently, gonadotrophin-releasing hormone analogues (GnRHa) have replaced clomiphene as part of many ovarian stimulation protocols. Clinical abortion rates after clomiphene (24.4% for IVF; 23.0% for GIFT) were not significantly higher than after GnRHa (20.7% for IVF; 17.9% for GIFT) when IVF and GIFT data were considered separately. However, the abortion rate for combined IVF and GIFT was significantly higher after clomiphene than after GnRHa. This pattern was found for most maternal age groups and causes of infertility although differences were not significant in all categories. The combined IVF and GIFT ectopic pregnancy rate of 6.7% for clomiphene was significantly higher than 4.1% for GnRHa. Because the mechanism of action of clomiphene for oocyte recruitment during folliculogenesis means that GnRHa cannot be used with clomiphene, luteinizing hormone (LH) levels are higher in clomiphene cycles than in GnRHa cycles. Clomiphene itself could cause the increase in pregnancy wastage or increased levels of LH during follicule genesis associated with the use of clomiphene may cause the observed pregnancy failures.     

Early pregnancy loss following assisted reproductive technology treatment

BACKGROUND: In women treated by assisted reproductive technology (ART), early pregnancy loss (EPL) reduces the initial success. Risk factors for EPL, however, have not been comprehensively studied. This study assesses some potential risk factors in ART pregnancies. METHODS: Altogether 1196 pregnancies, defined as serum hCG >or=10 IU/l on day 16 +/- 1 after oocyte retrieval, were included in this study. EPL was defined as pregnancy loss that occurred before 6-7 weeks gestation. Risk factors investigated were maternal age, body mass index (BMI), smoking and polycystic ovary syndrome (PCOS) status, infertility aetiology, response to stimulation, quality and number of embryos replaced and treatment type. RESULTS: Overall EPL was 16%. The risk of EPL was not linearly related to either age or BMI. Though women >40 years old had an increased risk, this was not significant after adjusting for other factors. The risk in both lean (BMI <18.5 kg/m(2)) and very obese (BMI >35 kg/m(2)) women was also not significantly higher in multivariate analysis. There was no effect of PCOS. Smoking or transfer of 'poor quality' embryo(s) was associated with a significant increased risk of EPL after adjusting for other factors. CONCLUSION: Smoking and transferring poor quality embryos increased EPL, while the effects of age, obesity and other risk factors were not significant in a multivariate analysis.     

Psychosocial adjustment during pregnancy for older couples conceiving through assisted reproductive technology

BACKGROUND: The trend to older maternal age at first birth is well established in Western countries and biological risk factors, particularly declining fertility, are well documented. Less is known, however, about the psychosocial well-being of older first time parents. This study explores differences in psychosocial adjustment during pregnancy in older (maternal age >or= 38 years) and younger (maternal age < 35 years) couples after assisted reproductive technology (ART) conception. METHODS: Questionnaire data were collected from a consecutive cohort of pregnant nulliparous women and their partners recruited over a 12-month period from ART clinics in Sydney, Australia. RESULTS: There were more similarities than differences when comparing older and younger couples. Older couples took longer to conceive and were more likely to use donor eggs. Older pregnant women scored higher on a measure of psychological hardiness/resilience and reported a lower identification with motherhood compared with younger pregnant women. Older men differed only in reporting a less satisfying social orientation during pregnancy (lower satisfaction with sex life, relationship with partner and social life). CONCLUSIONS: Findings do not indicate problematic adjustment during pregnancy in older couples, but differences found need further investigation using larger samples and prospective designs.     

Childhood outcomes of assisted reproductive technology

There is a large population of children conceived via assisted reproductive technology (ART), which continues to increase worldwide, without a clear understanding of associated long-term outcomes. ART children are more likely to be the result of multiple pregnancies, and thus to be born prematurely or low birthweight. There is growing evidence that ART children are phenotypically and biochemically different from naturally conceived children, but the mechanism(s) leading to these changes have not been elucidated. There is a possible increased risk of rare imprinted gene disorders in these children. However, it remains unclear whether more subtle changes in DNA methylation occur commonly, leading to differences in gene expression and phenotype in ART children. Although an increased risk of cancer among ART children has been reported, the role of ART in the development of cancer has not been demonstrated. Further research and ongoing surveillance of ART children is essential to better understand the possible effects of ART on the long-term health of this population.     

Community attitudes to maternal age and pregnancy after assisted reproductive technology: too old at 50 years?

Community attitudes toward oocyte and embryo donation, and towardassisted reproduction after the menopause were assessed in thissurvey of 1131 Australians. Of the respondents, 64.2% believedthat oocyte or embryo donation was an acceptable treatment forinfertile couples, 54.6% felt that it was a acceptable for awoman to have her own embryos transferred after the menopause,and 37.9% are accepting of the donation of eggs or embryos topost-menopausal women. There were no significant differencesin response amongst different religious groups, or in relationto gender or income level. Significantly higher levels of acceptancewere noted for all categories amongst those respondents aged< 35 years. Despite the established clinical ability to achievepregnancy in the over 50 years age group, this survey revealsonly minority community support for this practice. However,public opinion may alter in the future if the attitudes of theyounger proportion of the sample are maintained.     

Tubal surgery in the era of assisted reproductive technology: clinical options

We reviewed the place of tubal surgery in the era of assisted reproductive technology. Reversal of tubal ligation is one of the main indications for tubal microsurgery. Adhesiolysis has the best results if the adhesion is the only factor responsible for infertility. There are no differences between adhesiolysis by laparoscopy or by laparotomy, and so laparoscopy must be preferred. Proximal tubal obstructions can be successfully treated by microsurgical tubocornual anastomosis. As far as distal tubal lesions are concerned, success rates depend strictly on the pre-existing tubal disease in distal tubal lesions and tubal surgery frequently fails; in-vitro fertilization (IVF) must therefore be considered in such circumstances. In conclusion, we think that IVF and tubal surgery must be considered to be complementary rather than competitive procedures. Adequate selection of patients is crucial to find the best therapeutic approach.     

ART后自然减胎的相关因素及妊娠结局分析

目的探讨辅助生殖技术（ART）助孕妊娠后发生自然减胎（SPR）发生的相关因素和对妊娠结局的影响。方法回顾性分析2003年1月-2008年12月我院ART术后妊娠的3506例患者,分析与SPR有关的因素和妊娠结局。结果ART后SPR的发生与移植的胚胎质量有关;发生SPR后出生低体重儿和早产的可能性增大;SPR发生越晚,其产科异常结局风险越大。结论选择优质胚胎的单胚胎移植（SET）,可能是有效避免多胎妊娠,减少SPR发生的根本之举。此外,在对多胎妊娠实行选择性减胎时应充分考虑SPR的发生时间及发生率。     

双胎妊娠辅助生殖技术出生新生儿临床分析

目的比较体外受精(IVF)或冷冻胚胎(IVF-ET)术后出生的双胎新生儿与自然受孕双胎新生儿的健康状况,以了解第一代辅助生殖技术的安全性。方法观察2001年11月至2005年11月间在中国福利会国际和平妇幼保健院出生的176例体外受精(IVF)或冷冻胚胎(IVF-ET)术后出生的双胎妊娠儿与同期出生的198例自然受孕双胎儿在新生儿期的健康状况,比较两组母亲产前孕期情况及其新生儿的胎龄、体重、身长、Apgar评分、畸形发生率和新生儿并发症。结果IVF组与自然妊娠组母亲孕期并发症差异无显著性。两组新生儿在胎龄、出生体重和身长方面差异均无显著性,在出生时窒息发生率、畸形发生率、新生儿并发症发生率方面差异均无显著性。结论体外受精(IVF)或冷冻胚胎(IVF-ET)术后出生的双胎新生儿与自然受孕双胎新生儿的健康状况无差异,第一代辅助生殖技术出生的新生儿是安全的。