IVF-ET后发生异位妊娠或宫内外同时妊娠相关因素分析

目的:探讨IVF-ET治疗后发生异位妊娠的相关因素。方法:回顾性分析2006年1～10月在南方医院生殖医学中心行体外受精-胚胎移植(IVF-ET)治疗获得临床妊娠并有最终妊娠结局的203例患者的临床资料。结果:输卵管妊娠发生率为2.46%,宫内外同时妊娠的发生率为1.48%。异位妊娠及宫内外同时妊娠的8例患者均为盆腔卵管因素不孕,6例曾行腹腔镜检查及手术。与正常宫内妊娠组相比,女方年龄、基础激素水平(E2、P、LH、FSH和T)、HCG日激素水平(E2、P、LH)、促性腺激素总量、取卵日及HCG日内膜厚度、取卵数均无显著性差异(P>0.05)。异位妊娠组既往异位妊娠次数显著多于宫内妊娠组(P<0.05)。异位妊娠组优良胚胎形成率低于宫内妊娠组,但无显著性差异(P=0.064)。不同移植人员之间的异位妊娠率无显著性差异(P>0.05)。结论:对于异位妊娠高危患者可以考虑子宫中下段移植和单囊胚移植。异位妊娠的早期诊断非常重要,早期发现宫内外同时妊娠并及早手术,可以将对宫内胎儿的影响减至最低。

Factors analysis of ectopic or heterotopic pregnancy after IVF -ET treatment

Objective:To explore the factors resulting in ectopic or heterotopic pregnancy after IVF-ET treatment.Methods:A retrospective study was conducted between first January and thirty first October 2006 on 203 women who underwent IVF-ET.The patients' clinic data were compared between ectopic or heterotopic pregnancy group and intrauterin pregnancy group.Results:The ectopic pregnancy rate was 2.46%,as well as the heterotopic pregnancy rate was 1.48%.All of the 8 ectopic or heterotopic pregnancies were pelvic and tubal infertility women,6 of them had a history of laparoscope detecting and operation.No significant differences were observed in women' age,basal hormone levels(E2,P,LH,FSH and T),hormone levels on HCG injection day(E2,P,LH),total amount of gonadotropines,endomembrane's thickness on oocytes retrieval day and HCG injection day,the number of harvested oocytes between ectopic or heterotopic pregnancy group and intrauterin pregnancy group(P>0.05).Average ectopic pregnancies' times were significantly higher in the ectopic or heterotopic pregnancy group than that in the intrauterin pregnancy group(P<0.05).The high quality embryo rate was lower in the ectopic or heterotopic pregnancy group,but no statistical difference was found(P=0.064).The ectopic pregnancy rates were similar in groups dividing according to the transferring doctors(P>0.05).Conclusion:The application of middle and low position transferring and blastocyst transferring maybe effectively reduce the risk of occurrence of ectopic or heterotopic pregnancy after IVF-ET therapy.It is important to diagonse the ectopic pregnancy.The harmful effects on the intrauterine embryo will be maximally decreased by early diagnosis and treatment of heterotopic pregnancy.