State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China.
Reproductive Medicine Department, The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
Arch Gynecol Obstet. 2024 Apr;309(4):1597-1608. doi: 10.1007/s00404-023-07359-0. Epub 2024 Feb 3.
Our study aimed to investigate the best time to manage hydrosalpinx to improve pregnancy outcomes during in vitro fertilization-embryo transfer (IVF-ET).
Patients with hydrosalpinx who received IVF treatment were analyzed retrospectively. And two groups were included to compare the effects of different timing treatment of hydrosalpinx on IVF pregnancy outcomes, "Proximal Tubal Occlusion First Group" (Group Ligation-COH) and "Oocyte Retrieval First Group" (Group COH-Ligation). The main outcome measures included: ovarian response indexes, laboratory indexes and clinical pregnancy outcomes. Univariate and multivariate Logistic regression analysis was performed for outcome indicators, and the odds ratios (OR) and 95% confidence interval (CI) were used.
A total of 1490 patients were included (n = 976 Ligation-COH and n = 514 COH-Ligation). The Gn starting dose and MII rate in group Ligation-COH were significantly higher than those in group COH-Ligation (203.33 ± 58.20 vs. 203.33 ± 58.20, 81.58% vs. 80.28%, P < 0.05). The number of oocytes obtained and the number of available D3 embryos in group COH-Ligation were higher than those in group Ligation-COH (15.10 ± 7.58 vs. 13.45 ± 6.42, 10.92 ± 5.81 vs. 9.94 ± 5.15, P < 0.05). Although the number of ET cycles per IVF cycle in group COH-Ligation was higher than that in group Ligation-COH (1.88 ± 1.00 vs. 1.48 ± 0.70, P < 0.05), the biochemical pregnancy rate, clinical pregnancy rate, multiple pregnancy rate, live birth rate and cumulative live birth rate in group Ligation-COH were significantly higher than those in group COH-Ligation (60.83% vs. 46.27% for biochemical pregnancy, 55.69% vs. 38.5% for clinical pregnancy, 26.18% vs. 17.74% for multiple pregnancy, 47.08% vs. 25.26% for live birth, 69.47% vs. 47.47% for cumulative live birth, P < 0.05), and the miscarriage rate in group Ligation-COH was lower than that in group COH-Ligation (10.47% vs. 17.20 for early abortion, 4.49% vs. 15.86% for late abortion, P < 0.05). In logistic regression analysis, after adjustment for age and multiple factors, the above results were still statistically significant differences (P < 0.001). For elderly patients, the clinical pregnancy rate, multiple birth rate and live birth rate in group Ligation-COH were also higher than those in group COH-Ligation (P < 0.001). No significant differences were detected for patients with diminished ovarian reserve.
For the choice of ligation operation time, we recommend that patients choose tubal ligation first and then ovulation induction and oocyte retrieval treatment.
本研究旨在探讨在体外受精-胚胎移植（IVF-ET）中治疗输卵管积水以改善妊娠结局的最佳时机。
回顾性分析了接受 IVF 治疗的输卵管积水患者。并将两组患者的疗效进行比较，即“近端输卵管结扎术+控制性超排卵（COH）组”（结扎组）和“COH+取卵术组”（COH 组）。主要观察指标包括卵巢反应指标、实验室指标和临床妊娠结局。对结局指标进行单因素和多因素 Logistic 回归分析，计算比值比（OR）和 95%置信区间（CI）。
共纳入 1490 例患者（n=976 例结扎组和 n=514 例 COH 组）。结扎组 Gn 起始剂量和 MII 率明显高于 COH 组（203.33±58.20 比 203.33±58.20，81.58%比 80.28%，P<0.05）。COH 组获卵数和可移植胚胎数高于结扎组（15.10±7.58 比 13.45±6.42，10.92±5.81 比 9.94±5.15，P<0.05）。虽然 COH 组每 IVF 周期的 ET 周期数高于结扎组（1.88±1.00 比 1.48±0.70，P<0.05），但结扎组的生化妊娠率、临床妊娠率、多胎妊娠率、活产率和累积活产率均显著高于 COH 组（60.83%比 46.27%的生化妊娠，55.69%比 38.5%的临床妊娠，26.18%比 17.74%的多胎妊娠，47.08%比 25.26%的活产，69.47%比 47.47%的累积活产，P<0.05），且结扎组的流产率低于 COH 组（10.47%比 17.20%的早期流产，4.49%比 15.86%的晚期流产，P<0.05）。在多因素 Logistic 回归分析中，校正年龄和其他因素后，上述结果仍具有统计学意义（P<0.001）。对于老年患者，结扎组的临床妊娠率、多胎妊娠率和活产率也高于 COH 组（P<0.001）。对于卵巢储备功能减退的患者，两组间无显著差异。
对于结扎手术时间的选择，我们建议患者先进行输卵管结扎，然后再进行促排卵和取卵治疗。
