体外受精助孕并发异位妊娠92例分析

目的：探讨体外受精助孕中异位妊娠的发生率与影响因素。方法：对接受体外受精（invitro fertilization and embryo transfer，IVF）、单精子卵胞浆内注射（intracytoplasmic sperm injection，ICSI）、冻融胚胎移植（frozen-thawing embryo transfer，FET）助孕后发生异位妊娠病例的助孕指征、助孕方式、异位妊娠类型等进行回顾总结。结果：6007人次接受助孕治疗者，临床妊娠2322人次（38．7％），94人次为异位妊娠，发生率4．05％。其中输卵管妊娠92人次，发生率3．96％，占总异位妊娠病例的97．87％（92／94），其他部位2人次（腹腔妊娠和子宫角妊娠各1人次），发生率为0．86‰，占异位妊娠比例为2．32％。宫内宫外合并妊娠20人次，发生率为0．86％（20／2322），占异位妊娠病例的21．28％（20／94）。86例患者助孕指征为输卵管因素和／或盆腔粘连，占91．49％，其中24人有异位妊娠史（25．53％）。3种助孕方式（IVF-ET，ICSI和FET）比较，其总妊娠率差异无统计学意义（P〉0．05）。3组间异位妊娠发生率比较。IVF-ET组显著高于ICSI和FET组（均P〈0．05）；FET组亦显著高于ICSI组（P〈0．05）。结论：体外受精助孕异位妊娠发生率较自然受孕人群高，有输卵管病变史是发生异位妊娠的主要原因。

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OBJECTIVE: To investigate the occurrence of ectopic pregnancy among women who received in vitro fertilization and assess the influential factors. METHODS: The indications, methods of assisted conception and ectopic types were analyzed retrospectively after the patients received in vitro fertilization and embryo transfer (IVF-ET), intracytoplasmic sperm injection (ICSI), or freezing-thawing embryo transfer (FET). RESULTS: A total of 6007 embryo transfers were performed, and 2322 (38.7%) clinical pregnancies were obtained. Ninety-four (4.05%) of them were ectopic pregnancies; and 92 were tubal pregnancies. The occurrence rate was 3.96%, which constituted 97.87% (92/94) of all ectopic pregnancies. There were 2 cases of other parts: one in abdominal cavity and the other in cornual pregnancy with the occurrence rate of 0.86%, constituting 2.32% (2/94). Twenty heterotopic pregnancies occurred (0.86%), constituting 21.28% (20/94). Among all ectopic pregnancies, the assisted conception of 86 cases was tubal pathology and/or pelvic adherence (91.49%), and 24 patients had a history of ectopic pregnancy (25.53%). The differences of clinical pregnancy rates between IVF-ET, ICSI and FET were not significant (P>0.05). The ectopic rate of IVF-ET group was significantly higher than that of ICSI or FET group (P<0.05), respectively. The ectopic rate in FET group was also higher than that in ICSI group (P<0.05). CONCLUSION: The occurrence rate of ectopic pregnancy after IVF is higher than that of spontaneous pregnancy, and the main cause for ectopic pregnancy is the tubal pathological changes.