输卵管切除术对体外受精

输卵管切除术对体外受精 输卵管切除术对体外受精 【摘要】 目的:探讨输卵管切除术对体外受精 咛ヒ浦?IVF-ET)超促排卵中卵巢反应性及结局的影响。:选择2017年2月至2017年6月在本中心行常规IVF-ET治疗的179例不孕患者为研究对象，共分为A、B、C、D四组，A组为48例单侧输 卵管切除患者，B组为41例双侧输卵管切除患者，对照C组为50例双侧输卵管阻塞(不伴积水)患者，对照D组为40例单侧或双侧输卵管积水患者，比较4组患 者在IVF-ET周期中卵巢对控制性超排卵的反应及其结局的差异。结果:4组患者的基础FSH水平、窦卵泡数、使用促性腺激素(Gn)的时间、注射hCG日的E2水 平、冷冻胚胎数及受精率等指标均无明显差异(P,0.05);B组Gn的用量高于其他三组，其中与C组间的差异有显着性(P0.05);A、B两组注射hCG日的卵泡数及获卵数少于C、D两组，差异均有显着性(P,0.05);D组临床妊娠率为28.2%，低于B、C组，差异有显着性(P,0.05)。输卵管切除侧卵巢与对侧卵巢相比，窦卵泡 数、注射hCG日卵泡数及最终获卵数要明显少于对侧(P,0.05)。输卵管双侧切除患者中输卵管切除时间?2.5年侧的注射hCG日卵泡数及最终获卵数要明显少于切除时间?1年侧(P,0.05)。结论:输卵管切除术可改善输卵管积水患者的临床妊娠率，但增加IVF-ET周期中的Gn用量，减少获卵数，降低了超促排卵中卵巢的反应 性，并且将随着‎‎术后时间的延长进一步降低。 输卵管切除 受精 体外 胚胎移植 超排卵 Abstract: Objective: 【关键词】 To evaluate the influence of salpingectomy on ovarian response to superovulation and the oute in in vitro fertilization and embryo transfer (IVF-ET) program. Methods: The data of 179 patients undergoing IVF-ET in the Reproductive Medicine Center of the First Affiliated Hospital of WenZhou Medicinal College from February 2017 to June 2017 were analyzed retrospectively. The patients were divided into four groups. Group A included 48 women with previous unilateral salpingectomy. Group B included 41 patients with previous bilateral salpingectomy. Group C included 50 patients with obstruction of fallopian tube (without hydrosalpinx) while group D included 40 patients with hydrosalpinx (without surgical procedure before). The ovarian responses to superovulation and the outes of IVF-ET were evaluated. Results: There was more ampules of gonadotropin (Gn) administration in group B than that in another groups, and the difference between group B and group C has statistical significance (P0.05). There were significantly fewer developed follicles and oocytes retrieved in group A and group B than that in group C and group D (P0.05). The clinical pregnancy rate in group D (28.2%) was significantly lower than that in group B and group C (P0.05). There were no significant differences in other cycle characteristics among four groups(P0.05). Significantly fewer antral follicle count, developed follicles and consequently fewer oocytes were retrieved from the ovary which had salpingectomical history. For the patients who had undergone bilateral salpingectomy, there were significantly fewer developed follicles and fewer oocytes retrieved from the ovary whose salpingectomical history were over 2.5 years than those less than 1 year. Conclusion: Salpingectomy may improve the clinical pregnancy rate of patients with hydrosalyinx, but it increases the ampules of Gn administration and reduces the oocytes retrieved. Salpingectomy reduces the ovarian response to superovulation and is further lowered with the increase of post-operation time. Key words: salpingectomy; fertilization; in vitro; embryo transfer; superovulation 解剖学上卵巢与输卵管的血液供应非常邻近，输卵管手术有可能损伤卵巢血供而影响卵巢功能，但到目前为止，切除输卵管是否影响卵巢功能一直还有争议。本研究通过比较单侧或双侧输卵管切除及双侧输卵管阻塞的不孕患者在体外受精-胚胎移植(IVF-ET)周期超促排卵中卵巢的反应性，了解输卵管切除术对卵巢超排卵反应的影响，为临床治疗提供指导。 1 资料和方法 1.1 研究对象 选择2017年2月至2017年6月在本中心行常规IVF-ET治疗的179例不孕患者为研究对象，共分为A、B、C、D 四组。A组为因异位妊娠或输卵管积水行单侧输卵管切除术患者(对侧输卵管阻塞不伴积水)，共48例，年龄25,35岁(3 1.2?3.9)，不孕年限1,7年(3.1?2.8);B组为因异位妊娠或输卵管积水行双侧输卵管切除术患者，共41例，年龄26,35岁(3 1.5?3.4)，不孕年限0.5,5年(2.9?2.5);以同期因输卵管阻塞行IVF-ET治疗的不孕患者50例(不伴积水)为对照C组，年龄24,34岁(30.9?3.8)，不孕年限1,6年(3.0?2.6);以单侧或双侧输卵管积水患者40例为对照D组，年龄24,36岁(3 1.4?3.9)，不孕年限1,7年(3.2?2.8)。所有患者月经周期正常(21,35 d)，均为首次行IVF-ET治疗，年龄?36岁，无子宫肌瘤，既往无卵巢手术史，无合并子宫内膜异位症或多囊卵巢综合征及其他内分泌疾病。输卵管积水诊断标准为经腹腔镜或子宫输卵管碘油造影诊断为输卵管积水或经阴道B超能观察到输卵管积水图像。 1.2 方法 1.2.1 IVF-ET程序: 4组患者均采用GnRH-α/r-FSH或HMG(75IU)/hCG治疗。患者超促排卵、取卵、授精、胚胎移植及黄体支持均按本中心常规进行。移植胚胎后14 d查血hCG，如阳性，则在妊娠45 d行超声检查，B超检查有妊娠囊为临床妊娠。 1.2.2 观察指标: 包括基础血清卵泡刺激素(FSH)水平、双侧卵巢体积、窦卵泡数、各组促性腺激素总用量、用药天数、注射hCG日血E2水平及卵泡数、获卵数、受精数、冷冻胚胎数和临床妊娠率等指标。FSH采用放射免疫法测定，卵巢及卵泡大小的测量取其最大断面相互垂直的最大长横径平均值(mm)。 1.3 统计学处理 使用SPSS10.0软件包，组间均数差别的检验采用t检验及方差分析，四组间率的比较采用卡方检验。