体外受精与胚胎移植术后异位妊娠的单中心回顾性研究

目的探讨体外受精与胚胎移植术(IVF-ET)后异位妊娠(EP)的发生率、临床特点及应对措施。方法选择2010年1月至2015年12月于北京协和医院生殖中心经IVF-ET后确诊为EP的42例患者共计45个周期进行回顾性研究。结果 6年内共有3 656个周期为临床妊娠,42名患者共计45个周期为EP,比例为1.23%(45/3 656)。2名患者重复EP,5名患者宫内宫外同时妊娠(HP)。EP主要发生在输卵管壶腹部,共19周期,占EP的42.22%。因输卵管因素行IVF-ET后EP的患者有24周期(53.33%),非输卵管因素21周期(46.67%)。45周期EP中,3周期保守治疗,42周期采用腹腔镜或开腹手术治疗。5例HP患者中3例行手术+宫内孕保胎治疗,其中2例保胎成功最终娩出健康活婴。22名患者(52.38%)通过后续IVF-ET妊娠成功并产下健康活婴,3名患者(7.14%)暂时放弃生育计划,17名患者(40.48%)继续尝试IVF-ET。结论随着辅助生殖技术的改进与发展,其造成EP高风险或许会呈现逐渐降低趋势,但现今而言仍应引起我们高度重视。输卵管因素是EP发生的重要影响因素。在处理IVF-ET后患者时要考虑到IVF技术的特殊性,避免漏诊、误诊的发生。

A retrospective study of ectopic pregnancy after IVF-ET in a reproductive center

Objective:To investigate the incidence,clinical characteristics and rational solutions of ectopic pregnancy(EP) after IVF-ET.Methods:The data of the patients with ectopic pregnancy after IVF-ET in the reproductive center of Peking Union Medical College Hospital(PUMCH) from 2010 to 2015 were respectively analyzed.Results:Of the total 3 656 clinical pregnancies in six years,45 (1.23 ％) cycles in 42 patients were verified as ectopic.Two patients suffered repeated EP and five patients heterotopic pregnancy(HP).Of these EP,there were 19 cycles belonging to tubal pregnancies,which accounted for 42.22％ of all EP.Among 45 EP cycles,the assisted conceptions of 24 cycles were due to tubal factors(53.33％) and 21 cycles non-tubal factors(46.67％).Among the 45 cycles,3 cycles were given conservative treatment and 42 cycles received laparoscopy or laparotomy.Emergency laparoscopic ectopic pregnancy debridement and progesterone treatment for intrauterine pregnancy were performed in three of five HP patients.The postoperative pregnancies were uneventful in two patients and they delivered healthy babies through elective cesarean sections at last.There were 22 patients(52.38％) conceived successfully in the following IVF-ET and delivered healthy babies and 17 patients(40.48％) were still trying to get pregnant by means of IVF-ET.The rest of 3 patients(7.14％) gave up their birth plans for the moment.Conclusions:With the significant improvement in IVF technology,EP may be no longer a complication specifically associated with IVF-ET,but this complication should been paid great attention.Tubal factor may be the important factors for the incidence of EP.Doctors should take the particularity of IVF-ET into consideration when dealing with patients undergoing IVF-ET.