Jiang Xueyi, Jiang Shutian, Gao Hongyuan, Ye Jing, Kuang Yanping
Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
Acta Obstet Gynecol Scand. 2025 Apr;104(4):720-728. doi: 10.1111/aogs.15059. Epub 2025 Jan 27.
Ectopic pregnancy (EP) is a serious clinical gynecological emergency. Patients with EP history are at higher risk of EP resulting from IVF/ICSI (IVF-EP). Besides, studies have suggested that previous EP treatments may affect the incidence of IVF-EP. However, this result does not consider possible confounding factors due to the number of previous EP. Therefore, we assessed the impact of salpingectomy on the risk and characteristics of IVF-EP in patients with different previous spontaneous EP.
This retrospective cohort study included 43 647 patients receiving their first IVF/ICSI treatments at our center from January 2013 to June 2022. Cohorts were assigned according to the number of previous spontaneous EP by propensity score matching. After propensity score matching, there were 3252 participants in the no previous EP history cohort (NEP cohort), 3252 in the one EP history cohort (One-EP cohort), and 1571 in the 2 or more EP history cohort (> = 2 EP cohort). To assess the effect of previous salpingectomy on IVF-EP, One-EP cohort and > =2 EP cohort were divided into three subcohorts separately, according to their tubal statuses.
The IVF-EP rate was significantly higher in patients with EP history (NEP cohort: 1.3% vs. One-EP cohort: 2.2% vs. >=2 EP cohort: 2.0%, p = 0.023). In subcohort analysis, patients with different tubal statuses presented no statistical differences in IVF-EP rate (both in One-EP cohort and > =2 EP cohort). Considering the interaction between tubal status and number of previous EP, binary logistic regression was performed and it was demonstrated that bilateral salpingectomy might reduce the risk of IVF-EP in patients with recurrent EP history but increase the risk of non-tubal IVF-EP, while the history of spontaneous EP increased both IVF-EP and non-tubal IVF-EP rate.
Previous EP history was associated with a higher risk of IVF-EP and non-tubal IVF-EP. Salpingectomy reduced the overall risk of IVF-EP in patients with EP history, while bilateral salpingectomy increased the risk of non-tubal IVF-EP.
异位妊娠（EP）是一种严重的临床妇科急症。有异位妊娠病史的患者因体外受精/卵胞浆内单精子注射（IVF/ICSI）导致异位妊娠（IVF-EP）的风险更高。此外，研究表明，既往异位妊娠治疗可能会影响IVF-EP的发生率。然而，这一结果未考虑既往异位妊娠次数可能带来的混杂因素。因此，我们评估了输卵管切除术对不同既往自然发生异位妊娠患者IVF-EP风险及特征的影响。
这项回顾性队列研究纳入了2013年1月至2022年6月在本中心接受首次IVF/ICSI治疗的43647例患者。根据倾向评分匹配，按照既往自然发生异位妊娠的次数对队列进行分组。倾向评分匹配后，无既往异位妊娠病史队列（NEP队列）有3252名参与者，有一次异位妊娠病史队列（一次EP队列）有3252名，有两次或更多次异位妊娠病史队列（≥2次EP队列）有1571名。为评估既往输卵管切除术对IVF-EP的影响，一次EP队列和≥2次EP队列根据其输卵管状态分别分为三个亚组。
有异位妊娠病史的患者中IVF-EP发生率显著更高（NEP队列：1.3% vs. 一次EP队列：2.2% vs. ≥2次EP队列：2.0%，p = 0.023）。在亚组分析中，不同输卵管状态的患者在IVF-EP发生率上无统计学差异（一次EP队列和≥2次EP队列均如此）。考虑到输卵管状态与既往异位妊娠次数之间的相互作用，进行了二元逻辑回归分析，结果表明双侧输卵管切除术可能会降低复发性异位妊娠病史患者的IVF-EP风险，但会增加非输卵管性IVF-EP的风险，而自然发生异位妊娠病史会增加IVF-EP和非输卵管性IVF-EP的发生率。
既往异位妊娠病史与IVF-EP和非输卵管性IVF-EP的较高风险相关。输卵管切除术降低了有异位妊娠病史患者的IVF-EP总体风险，而双侧输卵管切除术增加了非输卵管性IVF-EP的风险。
