Direct gamete uterine transfer in patients with tubal absence or occlusion

Purpose: Our aim was to examine the potential of the uterine cavity to affect fertilization and early embryo development. Design: A prospective IRB-approved protocol for patients fulfilling study eligibility criteria was used. Methods: Patients studied included those with primary or secondary infertility, aged less than 38 years, with no history of severe male-factor infertility, and with hysterosalpingogram-and laparoscopic-confirmed bilateral proximal tubal occlusion. Superovulation induction was accomplished with a combination of GnRH agonist and menotropins, with serum hormonal and sonographic monitoring. Within 24 hr prior to, and again at the time of, ovulatory hCG administration, progesterone (P4) was given. Sonographic-guided transvaginal retrieval was performed 35 hr after hCG. Between four and six oocytes were returned to the uterine cavity, admixed with sperm, immediately following retrieval. Luteal support consisted of daily P4 administration. Results: Of the 20 patients recruited for the study, all completed the retrieval and transfer procedure. A total of four clinical pregnancies was achieved, with one early first-trimester loss, one late first-trimester loss (Trisomy 14), and two healthy term infants delivered. IVF of surplus oocytes demonstrated a 82.5% fertilization rate and 66.7% cleavage following cryopreservation. Conclusions: Human fertilization can be achieved through direct uterine transfer of gametes. Furthermore, administration of P4 prior to the ovulatory dose of hCG is compatible with in vitro or in vivo fertilization and implantation.     

Does Previous Salpingectomy Improve Implantation and Pregnancy Rates in Patients with Severe Tubal Factor Infertility who are Undergoing In Vitro Fertilization? A Pilot Prospective Randomized Study

Objective: To evaluate the implantation rate and pregnancy rate (PR) in patients with severe tubal factor infertility who were undergoing IVF. Patients who had undergone salpingectomy were compared with those who had not.

Design: A prospective randomized study.

Setting: A department of obstetrics and gynecology at a university hospital.

Patient(s): Thirty patients who previously had undergone salpingectomy and 30 patients who had not undergone salpingectomy before IVF treatment.

Intervention(s): Laparoscopy with or without salpingectomy followed by IVF with the use of combined GnRH agonist and hMG therapy in a long stimulation protocol.

Main Outcome Measure(s): Embryo implantation rate and ongoing PR per transfer. The cumulative PRs were compared for the two groups of patients.

Result(s): After the first IVF attempt, the implantation rate was 10.4% in the group with salpingectomy and 4.6% in the group without salpingectomy. For all IVF attempts, the respective embryo implantation rates in the two groups were 13.4% and 8.6%. The ongoing PR per transfer was 34.2% in the group with salpingectomy compared with 18.7% in the group without salpingectomy. After four IVF attempts, the probability of becoming pregnant was greater in the group of patients with salpingectomy (75%) than in the group without salpingectomy (63%).

Conclusion(s): Previous salpingectomy in patients with severe tubal factor infertility who are undergoing IVF seems to increase the embryo implantation rate and the PR per cycle of IVF. This monocentric study must be followed by other similar studies to allow for a metaanalysis and confirm this clear trend with definitive evidence.     

中药配合经阴输卵管插管注射甲氨喋呤治疗输卵管妊娠临床观察

探讨透视下经阴输卵管妊娠囊表面注射甲氨喋呤(MTX),配合口服异位汤,静脉用丹参注射液的方法,治疗输卵管妊娠的近期与远期效果及适应症。结果:10例患者8例成功。近期疗效:治疗后8例患者阴道流血时间平均9.7天;恢复排卵时间19.71天;治疗后22天血β-hCG降至正常,同时B超见输卵管妊娠包块直径<1.6cm。远期疗效:8例患者5例未避孕,4例获得宫内妊娠(4/5)。其中2例足月分娩,出生儿智力、发育及健康状况均正常。     

未破裂型输卵管妊娠腹腔镜手术和剖腹手术的临床研究

目的　比较腹腔镜和剖腹手术在保守性治疗未破裂型输卵管妊娠的效果。　方法　选取经临床或腹腔镜确诊的输卵管峡部、壶腹部或伞部妊娠的未破裂型住院病例 ,分成腹腔镜手术和剖腹手术 2组进行保守性手术治疗 ,2组各 112例 ,记录术前病史体征、术中和术后情况 ,并随访其术后 1年内的妊娠结局。　结果　腹腔镜组术中出血量 (30 .6± 13.8) m l、手术时间(4 1.3± 11.2 ) m in、排气时间 (11.5± 5 .3) h、抗生素应用时间 (2 .6± 2 .1) d、术后最高体温 (36 .8± 0 .4 )℃、术后住院时间 (4 .3± 1.2 ) d及术后 3个月后子宫输卵管造影 (hystero salpingo graphy,HSG)通畅率 83.9% (78/ 112 ) ,明显优于剖腹组 (P<0 .0 5 ) ;腹腔镜组和剖腹组术后血β- HCG恢复正常时间分别为 (9.6± 5 .1) d、(10 .2± 4 .9) d;术后发生持续性宫外孕率分别为 (6 .3% ,5 .4 % )、术后 1年内的宫内妊娠率分别为 (87.9%、 76 .5 % )及宫外孕发生率分别为 (12 .6 % ,2 3.5 % ) ,2组间差异无显著 (P>0 .0 5 )。　结论　腹腔镜保守治疗未破裂型输卵管妊娠具有手术时间短、出血少、术后恢复块、 HSG通畅率高     

整合素β_1在人输卵管及输卵管妊娠黏膜上皮中的表达

目的:检测整合素β1在人输卵管和输卵管妊娠黏膜上皮中的表达。方法:29例人输卵管组织标本取自因子宫肌瘤、子宫腺肌症等行全子宫加附件切除术的患者。输卵管标本包括峡部、壶腹部和伞部,按子宫内膜组织学分期将标本分为增生早期组(n=8)、增生中-晚期组(n=6)、分泌早期组(n=7)和分泌中-晚期组(n=8)。17例输卵管妊娠组织标本取自输卵管壶腹部妊娠的患者,标本分为种植部位组(n=17)和非种植部位组(n=17)。应用免疫组织化学法检测整合素β1在上述各组黏膜上皮中的表达。结果:整合素β1表达于人输卵管黏膜上皮纤毛细胞和分泌细胞的胞质,其中纤毛细胞的纤毛亦有表达。输卵管峡部及壶腹部黏膜的整合素β1表达水平,不同时期组间的比较无显著性差异(P>0.05);在输卵管伞部,分泌早期组的表达水平显著高于增生早期、增生中-晚期及分泌中-晚期组(P<0.05);在月经周期同一时期,输卵管峡部、壶腹部及伞部间的比较无显著性差异(P>0.05)。在输卵管妊娠黏膜,种植部位的滋养层细胞和蜕膜细胞的胞质可见阳性表达,种植部位的整合素β1表达水平显著高于非种植部位(P<0.05);种植部位和非种植部位的表达水平均显著高于分泌期壶腹部(P<0.05)。结论:整合素β1在分泌早期输卵管伞部黏膜的表达水平升高,在输卵管妊娠种植部位黏膜中表达水平亦升高。     

经脐单孔腹腔镜输卵管妊娠开窗取胚术19例分析

目的探讨经脐单孔腹腔镜输卵管妊娠开窗取胚术的可行性。方法对2010年3-9月在南方医科大学广济医院住院的20例输卵管妊娠患者行经脐单孔腹腔镜输卵管开窗取胚术。结果除1例术中发现为间质部妊娠改为三孔手术外,其余19例手术全部成功,术后监测血β-绒毛膜促性腺激素(HCG)均未发生持续性异位妊娠。结论经脐单孔腹腔镜输卵管开窗取胚术是一种安全可行、更加理想的微创术式,在实施中应注意正确、严格地选择病例,提高手术技巧,术后严密观察血β-HCG的下降。     

经脐单孔腹腔镜下输卵管切除术治疗输卵管妊娠156例疗效观察

目的 探讨经脐单孔腹腔镜下输卵管切除术对输卵管异位妊娠的疗效.方法 将296例输卵管妊娠患者分为单孔组与常规组,对两组术中、后情况、切口美容效果及患者满意情况进行比较,并行统计学分析.结果 (1)单孔组患者肛门排气时间(32.6± 11.6)h与常规组(34.1±10.2)h(P =0.883);术中出血量(48.7±15.2)ml与常规组(41.5 10.9) ml(P =0.313)均差异无统计学意义;单孔组手术时间(62.6±21.6)min长于常规组(42.7±17.6) min(P =0.000),下床活动时间及需求镇痛例数明显少于常规组(P=0.003;P =0.001).(2)单孔组美容效果判定良好率96.8％,患者表示不满率1.2％;常规组美容效果判定良好率86.4％;患者表示不满率9.3％;两组美容效果判定良好率差异有统计学意义(P=0.004),且单孔组患者表示不满率低于常规组.结论 输卵管妊娠患者行经脐单孔腹腔镜下输卵管切除术是一种更微创的安全可行并具更佳美容效果的一种妇科术式;尽管有一定的难度.     

氨甲蝶呤在腹腔镜输卵管妊娠保守性手术中应用

目的探讨腹腔镜输卵管妊娠保守性手术后,选择性应用氨甲蝶呤(MTX)预防持续异位妊娠发生的价值。方法对我院妇产科住院要求保留生育功能而行腹腔镜保守性手术的输卵管妊娠患者78例,监测其术前,术后第1、3、10天血人绒毛膜促性腺激素(HCG)的变化。对术后第1天HCG值较术前下降<50%者13例,应用MTX50mg/m224h行单次肌肉注射,余65例术后第1天HCG值较术前下降>50%者,不用MTX治疗。结果应用MTX治疗的13例患者无1例出现严重不良反应。全组患者无1例发生持续异位妊娠需要再手术。结论把腹腔镜输卵管妊娠保守性手术后第1天HCG水平下降情况作为预测持续异位妊娠的参数,对下降<50%者考虑及早使用MTX单次肌肉注射,可减少持续异位妊娠发生。方法简单、方便、疗效肯定,具有实用价值。     

中西医结合治疗输卵管性不孕60例分析

目的:研究中西医结合方法治疗输卵管性不孕的临床疗效。方法:输卵管性不孕患者共60例,随机分为两组,中西医结合治疗组及单纯西医治疗组,各30例。结果:输卵管性不孕患者其中西医结合综合疗法治疗组(治疗组)的临床疗效明显高于西医治疗组(对照组),差异有显著性(P<0.05)。结论:中西医结合治疗输卵管性不孕的疗效明显高于单纯西医治疗。     

IVF-ET术后宫内妊娠合并输卵管妊娠的诊治及妊娠结局分析

目的 分析体外受精-胚胎移植(1VF-ET)术后宫内妊娠合并输卵管妊娠的诊治及妊娠结局.方法 回顾性分析2014年3月至2019年6月于我院诊治的IVF-ET周期宫内妊娠合并输卵管妊娠患者50例的临床资料.分析其临床特征、超声表现、治疗方式及妊娠结局等.结果 (1)本研究50例患者中10例(20.0％)无明显症状,16...