盆腔炎性疾病对不孕患者体外受精-胚胎移植结局的影响

目的 探讨不同程度盆腔炎性疾病（PID）及手术中是否切除输卵管对体外受精-胚胎移植（IVF-ET）治疗结局的影响。方法 选取223个IVF-ET周期,根据IVF治疗周期前手术所见,按PID盆腔病变程度分为轻度组72个周期、中度组79个周期、重度组72个周期,分别统计并分析各组间及组内手术是否切除输卵管与IVF周期中所用促性腺激素（Gn）总量、获卵数、卵巢低反应发生率、受精率、优质胚胎数及新鲜胚胎移植周期临床妊娠率的关系。结果 所需Gn总量、获卵数、优质胚胎数轻度组分别为（2057±503）IU／L、（16±6）个和（6．0±4．3）个;中度组分别为（2204±603）IU／L、（12±6）个和（4．5±3．5）个;重度组分别为（2372±1018）IU／L、（9±6）个和（3．1±2．9）个;重度组与轻度组IVF周期所需Gn总量比较,明显增加,差异有统计学意义（P〈0．05）;重度组较轻度组获卵数及优质胚胎数均下降,差异也有统计学意义（P〈0．01）。卵巢低反应发生率,轻度组为4．2％,中度组为13．9％,重度组为33．8％,3组两两比较,差异均有统计学意义（P〈0．05）。临床妊娠率轻度组为63．9％,中度组为46．8％,重度组为41．2％,3组两两比较,差异均也有统计学意义（P〈0．05）。3组受精率比较,差异无统计学意义（P〉0．05）。轻度组与重度组比较,PID手术中是否切除输卵管对术后IVF-ET结局无显著影响;而中度组切除输卵管者的获卵数、优质胚胎数、临床妊娠率均高于保留输卵管者,两者比较,差异有统计学意义（P〈0．05）。结论 PID病变降低卵巢的反应性及临床妊娠率,影响IVF-ET结局;PID患者行手术治疗时,手术中是否切除病变输卵管应视病变程度而定,但应尽可能地游离卵巢组织。

Effect of pelvic inflammatory disease grades on in vitro fertilization-embryo transfer outcome

OBJECTIVE: To evaluate the effect of different grades of pelvic inflammatory disease (PID) and of salpingectomy on outcomes of in vitro fertilization-embryo transfer (IVF-ET). METHODS: Two hundred and twenty three cycles of IVF-ET were divided into three groups, including mild group, moderate group and severe group, according to different grades of sequelae of PID finding in exploratory operations before IVF. Patients in each group were divided into two subgroups according to receiving salpingectomy or not. The data of total dose of gonadotrophin (Gn), oocyte number, low response rate, fertilization rate, good embryo number and pregnancy rate were analysed between three groups and the two subgroups of each group, respectively. RESULTS: All parameters were related to PID grades except fertilization rate. The total dose of Gn, oocyte number, good embryo number, low response rate and pregnancy rate were (2057 +/- 503) IU/L, (16 +/- 6), (6.0 +/- 4.3), 4.2%, 63.9% in mild group; (2204 +/- 603) IU/L, (12 +/- 6), (4.5 +/- 3.5), 13.9%, 46.8% in moderate group; and (2372 +/- 1018) IU/L, (9 +/- 6), (3.1 +/- 2.9), 33.8%, 41.2% in severe group. The total dose of Gn and low response rate increased with the aggravation of the grades of PID (P < 0.05). The oocyte number, good embryo number and pregnancy rate also had significant differences between three groups (P < 0.01, P < 0.01, P < 0.05, respectively). In mild and severe groups, the salpingectomy had no contribution to the outcome of IVF-ET treatment. In moderate group, patients receiving salpingectomy had more oocytes and good embryos and higher pregnancy rate than the others who retained oviducts (P < 0.05). CONCLUSIONS: Grades of PID have an adverse effect on IVF-ET outcomes. Receiving salpingectomy or not should be based on different grades of PID, but operations of ovary-free should be performed in all patients.