体外受精——胚胎移植前输卵管积水处理方法探讨

目的:探讨体外受精-胚胎移植(IVF-ET)前输卵管积水处理方法。方法:回顾性分析因女性输卵管因素不孕 行IVF-ET治疗的497周期资料,按处理方法不同分为4组,A组:输卵管积水未处理直接行IVF-ET 43周期;B组:在IVF- ET前腹腔镜切除积水输卵管29周期;C组超排卵前及取卵时均抽吸输卵管积水65周期;D组:输卵管阻塞,无积水360周期。结 果:A、B、C、D组IVF-ET的种植率分别是10.1％、18.3％、19.2％、19.5％,临床妊娠率分别为20.9％、37.9％、38.5 ％、45.0％,A组的种植率及临床妊娠率较其他组明显降低;B组促排卵用药量,获卵数较其他组显著降低,异位妊娠发生率显 著降低,有统计学意义。结论:切除积水之输卵管及抽吸输卵管积水均可改善IVF-ET结局。前者异位妊娠发生率降低,促卵药 量增加,获卵减少;后者简单、安全、损伤小,应结合患者具体情况,做出最佳选择。

The Approach of the Treatmeat before in Vitro Fertilization and Embryo Transfer on Patients with Hydrosalpinx

Objective: To evaluate the different treatments before in Vitro Fertilization and Embryo Transfer (IVF-ET) in patients with hydrosalpinx. Methods: Data of 497 cycles with tubal factor infertility of IVF-ET . Patients were divided into four groups according to different treatments options of hydrosalpinx: Group A: 43 cycles without treatment of hydrosalpinx before IVF -ET; Group B : 29 cycles with salpingostomy performed under Laparoscope before IVF-ET; Group C: 65 cycles take out the tubal fluid before superovulation and follicle retrieved ; Group D: 360 cycles with Fallopian tube obstruction but no hydrosalpinx. Results: IVF-ET implantation rate was 10. 1%,18. 3%,19. 2% and 19. 5% respectively, and pregnancy rate was 20. 9%,37. 9%, 38. 5% and 45. 0% respectively . implantation rate and pregnancy rate in group A were significantly lower than that in the other three groups . The medicine dose and retrieved follicles of groupB were lower than that of the other groups, but the ectopic pregnancy rate of group B was significantly lower than that of other groups. Conclusion: Removal of hydrosalpinx by salpingectomy and take out tubal fluid both can improve the result of IVF-ET . the former, s ectopic pregnancy rate is lower , the medicine dose is higher , the retrieved follicles are less ; the latter is more simply , safety and has small chance to be injured . different treatment should be choosed to different patients.