Csemiczky G, Landgren B M, Fried G, Wramsby H
Department of Woman and Child Health, Karolinska Hospital, Stockholm, Sweden.
Hum Reprod. 1996 Nov;11(11):2438-40. doi: 10.1093/oxfordjournals.humrep.a019132.
In order to analyse the relationship between grade of tubal damage and pregnancy rate following in-vitro fertilization (IVF) treatment, 50 consecutive couples with isolated tubal infertility who underwent IVF without previous reconstructive surgery were studied. The couples had tried to conceive for 2.5-5.6 years (mean 3.9 years) and had gone through a complete investigation for infertility. All women fulfilled the standard criteria for normal ovulatory cycles. All males had normal spermiograms. Tubal function was in each case evaluated by hysterosalpingography and laparoscopy. Grade of tubal damage was classified on a scale of I-IV. Patients with milder tubal damage (groups I-II) showed considerably higher take-home baby rate per started cycle (48%) than patients with severe tubal damage (group IV; 6%) (P < 0.001) even though patients in group IV underwent more treatment cycles than patients in groups I-II (2.7 versus 1.8; P < 0.01). In the first treatment cycle nine out of 12 patients in groups I-II became pregnant as compared with only one out of 16 in group IV (P < 0.01). As indicators of lower ovarian response, the women in group IV needed a higher number of gonadotrophin ampoules per cycle (P < 0.001) and exhibited lower pre-ovum retrieval oestradiol concentrations (P < 0.001). Oocyte retrievals per started cycle (I-II: 100%; III: 98%; IV: 84%) did not differ significantly between the groups, neither did pre-embryo replacements (I-II: 95%; III: 80%; IV: 73%) nor pre-embryos per replacement (I-II: 3.0; III: 2.9; IV: 2.8). The present results concerning the role of tubal damage grade for the outcome of IVF treatment should be considered in patient counselling. Further studies are needed to elucidate the mechanisms by which the extent of tubal damage may impair ovarian function and reduce IVF outcome.
为了分析输卵管损伤程度与体外受精（IVF）治疗后妊娠率之间的关系，我们研究了50对连续的单纯输卵管性不孕夫妇，他们接受了IVF治疗且之前未进行过重建手术。这些夫妇尝试受孕2.5 - 5.6年（平均3.9年），并完成了不孕症的全面检查。所有女性均符合正常排卵周期的标准标准。所有男性精液检查正常。每种情况下输卵管功能均通过子宫输卵管造影和腹腔镜检查进行评估。输卵管损伤程度分为I - IV级。输卵管损伤较轻的患者（I - II组）每个启动周期的抱婴回家率（48%）显著高于输卵管损伤严重的患者（IV组；6%）（P < 0.001），尽管IV组患者比I - II组患者接受了更多的治疗周期（2.7对1.8；P < 0.01）。在第一个治疗周期中，I - II组12名患者中有9名怀孕，而IV组16名患者中只有1名怀孕（P < 0.01）。作为卵巢反应较低的指标，IV组女性每个周期需要更高数量的促性腺激素安瓿（P < 0.001），并且在取卵前表现出较低的雌二醇浓度（P < 0.001）。各组之间每个启动周期的取卵率（I - II组：100%；III组：98%；IV组：84%）、胚胎移植前的移植率（I - II组：95%；III组：80%；IV组：73%）以及每次移植的胚胎数（I - II组：3.0；III组：2.9；IV组：2.8）均无显著差异。在患者咨询中应考虑目前关于输卵管损伤程度对IVF治疗结果作用的这些结果。需要进一步研究以阐明输卵管损伤程度可能损害卵巢功能并降低IVF治疗结果的机制。
