Freeman M R, Whitworth C M, Hill G A
Center for Assisted Reproduction and Reproductive Endocrinology, Nashville Fertility Center, TN 37203, USA.
Hum Reprod. 1998 Apr;13(4):983-6. doi: 10.1093/humrep/13.4.983.
Recent reports suggest a deleterious effect of hydrosalpinges on pregnancy outcome for in-vitro fertilization (IVF) and improvement following surgical treatment. We compared the effect of hydrosalpinx on pregnancy outcome in 286 patients having 348 IVF cycles and followed the development of untransferred embryos for 7 days to determine if hydrosalpinges affect oocyte quality or embryo development. The delivery rate per retrieval was significantly lower for patients with hydrosalpinx, but was restored by surgical treatment to that of patients without hydrosalpinx. However, the implantation rate per embryo transferred and normal blastulation of untransferred embryos, which were significantly decreased in patients with hydrosalpinx, and growth arrest and degeneration of untransferred embryos, which were significantly increased compared to patients without hydrosalpinx, were not restored by surgical treatment of hydrosalpinges. We conclude that surgical treatment of hydrosalpinges decreases early pregnancy loss and improves pregnancy outcome, possibly by diminishing reversible deleterious effects exerted on the endometrium. As we have seen in our laboratory, hydrosalpinges may have a permanent negative influence on ovarian function, follicular development and oocyte quality since implantation of transferred embryos and normal blastulation of untransferred embryos remain low, and in-vitro growth arrest and degeneration remain high despite surgical treatment of hydrosalpinges.
近期报告显示，输卵管积水对体外受精（IVF）的妊娠结局有不良影响，手术治疗后情况有所改善。我们比较了286例患者348个IVF周期中输卵管积水对妊娠结局的影响，并对未移植胚胎的发育情况进行了7天的跟踪，以确定输卵管积水是否会影响卵母细胞质量或胚胎发育。有输卵管积水的患者每次取卵后的分娩率显著较低，但手术治疗后可恢复到无输卵管积水患者的水平。然而，有输卵管积水的患者每次移植胚胎的着床率和未移植胚胎的正常囊胚形成率显著降低，未移植胚胎的生长停滞和退化率与无输卵管积水的患者相比显著增加，输卵管积水手术治疗后这些情况并未恢复。我们得出结论，输卵管积水的手术治疗可减少早期妊娠丢失并改善妊娠结局，可能是通过减少对子宫内膜的可逆性有害影响来实现的。正如我们在实验室中所观察到的，输卵管积水可能对卵巢功能、卵泡发育和卵母细胞质量产生永久性负面影响，因为尽管进行了输卵管积水手术治疗，但移植胚胎的着床率和未移植胚胎的正常囊胚形成率仍然较低，体外生长停滞和退化率仍然较高。
