Gelbaya Tarek A, Nardo Luciano G, Fitzgerald Cheryl T, Horne Greg, Brison Daniel R, Lieberman Brian A
Department of Reproductive Medicine, Saint Mary's Hospital, Manchester, United Kingdom.
Fertil Steril. 2006 May;85(5):1464-8. doi: 10.1016/j.fertnstert.2005.10.036. Epub 2006 Apr 3.
To compare the effect of prophylactic laparoscopic salpingectomy versus division of the fallopian tubes on ovarian response to gonadotropins in women undergoing IVF.
Retrospective study.
National Health Service-based tertiary referral center for reproductive medicine.
PATIENT(S): One hundred sixty-eight women with tubal factor infertility. Sixty-five women with hydrosalpinges had either salpingectomy (n = 40, group A) or proximal tubal division (n = 25, group B), while the remaining women with tubal disease but without hydrosalpinges acted as the control group (n = 103, group C).
INTERVENTION(S): Prophylactic laparoscopic salpingectomy or proximal division of the fallopian tubes and ovarian stimulation with gonadotropins for IVF.
MAIN OUTCOME MEASURE(S): Day 2 serum FSH levels before surgery and 3 months after surgery but before ovarian stimulation, ovarian response assessed as total dose of hMG administered, serum E2 concentrations on day 3 and day 8 of stimulation and on the day of hCG injection, number of follicles, and number of oocytes retrieved and fertilized.
RESULT(S): In group A, baseline FSH levels were significantly raised after surgery compared with before surgery. Postsurgery FSH concentrations were significantly higher in group A compared with group B. The number of follicles (15-20 mm) was significantly lower in group A compared with group B and group C. The serum E2 levels on day 8 of stimulation were lower in group A compared with group B, and on the day of hCG injection it was significantly reduced in group A compared with groups B and C. The number of oocytes retrieved per cycle was significantly lower in group A compared with group B. There were no significant differences in pregnancy rates and miscarriage rates among the three groups.
CONCLUSION(S): These findings suggest that prophylactic salpingectomy in women with hydrosalpinx may compromise ovarian response to stimulation without affecting pregnancy rates. A randomized control trial is recommended to determine the most appropriate laparoscopic procedure in the management of hydrosalpinx before IVF.
比较预防性腹腔镜输卵管切除术与输卵管切断术对接受体外受精（IVF）女性卵巢对促性腺激素反应的影响。
回顾性研究。
基于国民医疗服务体系的生殖医学三级转诊中心。
168例输卵管因素不孕症女性。65例输卵管积水女性接受了输卵管切除术（n = 40，A组）或输卵管近端切断术（n = 25，B组），其余有输卵管疾病但无输卵管积水的女性作为对照组（n = 103，C组）。
预防性腹腔镜输卵管切除术或输卵管近端切断术，并使用促性腺激素进行卵巢刺激以进行IVF。
术前及术后3个月但在卵巢刺激前的第2天血清促卵泡激素（FSH）水平、以注射用促性腺激素（hMG）总剂量评估的卵巢反应、刺激第3天、第8天及注射人绒毛膜促性腺激素（hCG）当天的血清雌二醇（E2）浓度、卵泡数量、获取及受精的卵母细胞数量。
A组术后基线FSH水平较术前显著升高。A组术后FSH浓度显著高于B组。A组15 - 20毫米卵泡数量显著低于B组和C组。A组刺激第8天血清E2水平低于B组，注射hCG当天A组血清E2水平较B组和C组显著降低。A组每个周期获取的卵母细胞数量显著低于B组。三组妊娠率和流产率无显著差异。
这些发现表明，输卵管积水女性进行预防性输卵管切除术可能会损害卵巢对刺激的反应，但不影响妊娠率。建议进行随机对照试验以确定IVF前处理输卵管积水最合适的腹腔镜手术。
