-
体外受精-胚胎移植(in vitro fertilization - embryo transfer,IVF-ET)自问世以来,已为许多不孕不育症病人解决了生育需求,但部分接受IVF-ET病人仍然会出现不良妊娠结局[1]。输卵管阻塞、粘连等是导致不孕的重要原因,为减少炎症影响、改善子宫内发育环境,临床常会对存在输卵管性不孕的病人进行疏通、切除、修复等治疗,以提高IVF-ET的成功率,减少相关并发症[2]。有研究[3]指出输卵管与卵巢存在动脉血流重合,因此切除输卵管可能会影响卵巢血供,进而导致卵子质量或人工授精成功率降低。但此说法还缺乏验证,且单侧与双侧输卵管切除对IVF-ET结果是否存在本质上的区别,还不得而知。抗苗勒管激素(anti-mullerian hormone,AMH)常用于衡量卵子储备,与卵泡生长发育及闭锁有重要关系,也是评估生殖辅助技术预期效果的常用指标[4]。为明确单侧输卵管切除后IVF-ET对AMH等的影响,本文选取200例IVF-ET病人进行研究对比。
-
A组的AMH、LH、E2显著低于B、C组,A组的FSH、P显著高于B、C组,B组的AMH显著低于C组,差异均有统计学意义(P < 0.05~P < 0.01);B组与C组的FSH、LH、E2、P比较,差异均无统计学意义(P>0.05)(见表 1)。
分组 n AMH/(ng/mL) FSH/(U/L) LH/(U/L) E2/(pg/mL) P/(nmol/L) A组 70 2.98±0.53 7.46±1.25 3.46±0.78 41.31±4.72 3.84±0.77 B组 70 3.82±0.65** 6.92±1.20** 3.97±0.83** 45.27±6.08** 3.22±0.71** C组 70 4.64±0.79**## 6.87±1.09* 4.05±0.88** 46.16±6.37** 3.05±0.60** F — 103.02 5.15 10.07 13.60 23.50 P — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 MS组内 — 0.433 1.408 0.686 32.903 0.492 q检验:与A组比较*P < 0.05,**P < 0.01;与B组比较##P < 0.01 表 1 3组AMH和卵巢功能比较(x±s)
-
A组的双侧AFC显著低于B组、C组,A组的Gn用量显著高于B组、C组,B组的Gn用量显著高于C组,差异均有统计学意义(P < 0.05~P < 0.01);A组的Gn使用时间高于B组和C组,B组的Gn使用时间高于C组(P < 0.05~P < 0.01)(见表 2)。
分组 n 双侧AFC/个 Gn使用时间/d Gn用量/U A组 70 10.43±2.17 12.58±2.36 3567.38±384.69 B组 70 13.26±3.25** 11.72±2.20* 2845.72±290.45** C组 70 14.05±3.59** 10.69±1.87**## 2709.50±278.93**# F — 26.31 11.90 136.62 P — < 0.01 < 0.01 < 0.01 MS组内 — 9.209 4.851 104 681.721 q检验:与A组比较*P < 0.05,**P < 0.01;与B组比较#P < 0.05,##P < 0.01 表 2 3组AFC和Gn使用时间、Gn用量比较(x±s)
-
3组的取卵数比较差异无统计学意义(P>0.05);A组的有效胚胎、优质胚胎数显著低于B组、C组,差异均有统计学意义(P < 0.01)(见表 3)。
分组 n 取卵数 有效胚胎 优质胚胎 A组 70 14.02±3.15 8.68±1.24 4.03±0.79 B组 70 14.21±3.22 10.90±1.82** 5.86±1.12** C组 70 14.35±3.30 11.34±2.27** 6.18±1.30** F — 0.17 42.17 77.86 P — >0.05 < 0.01 < 0.01 MS组内 — 10.368 3.242 1.164 q检验:与A组比较**P < 0.01 表 3 3组取卵数、有效胚胎、优质胚胎比较(x±s;个)
-
A组的流产率显著高于C组,足月分娩率显著低于B组、C组,差异均有统计学意义(P < 0.05~P < 0.01)(见表 4)。
分组 n 总妊娠数 流产 早产 足月分娩 A组 70 52(74.29) 14(26.92) 8(11.43) 30(57.69) B组 70 61(87.14) 6(9.84) 5(8.20) 50(81.97)** C组 70 53(88.33) 4(7.55)* 3(5.66) 46(86.79)** χ2 — 5.83 6.64 1.92 19.13 P — >0.05 < 0.05 >0.05 < 0.01 q检验:与A组比较*P < 0.05,**P < 0.01 表 4 3组妊娠结局比较[n;百分率(%)]
IVF-ET单侧输卵管切除对血清AMH水平及卵巢功能的影响
Effect of IVF-ET unilateral salpingectomy on the serum levels of AMH and ovarian function
-
摘要:
目的 研究体外受精-胚胎移植(IVF-ET)单侧输卵管切除对血清抗苗勒管激素(AMH)水平及卵巢功能的影响。 方法 选择200例IVF-ET病人作为研究对象,根据其是否进行过输卵管切除分为A组70例(双侧切除),B组70例(单侧切除),C组60例(无切除)。比较3组注射日的AMH和卵巢功能,双侧卵巢窦卵泡数(AFC)、促性腺激素(Gn)使用时间、Gn用量,取卵数、有效胚胎、优质胚胎,总妊娠数、流产、早产、足月分娩。 结果 A组的AMH、促黄体生成素、雌二醇显著低于B、C组,A组的血清卵泡刺激素、孕酮显著高于B、C组,B组的AMH显著低于C组,差异均有统计学意义(P < 0.05~P < 0.01);B组与C组的促黄体生成素、雌二醇、血清卵泡刺激素、孕酮比较,差异均无统计学意义(P>0.05)。A组的双侧卵巢窦卵泡数显著低于B组、C组,A组的Gn用量显著高于B组、C组,B组的Gn用量显著高于C组,差异均有统计学意义(P < 0.05~P < 0.01);A组的Gn使用时间高于B组和C组,B组的Gn使用时间高于C组(P < 0.05~P < 0.01)。3组的取卵数比较差异均无统计学意义(P>0.05);A组的有效胚胎、优质胚胎数显著低于B组、C组,差异均有统计学意义(P < 0.05)。A组的流产率显著高于C组,足月分娩率显著低于B组、C组,差异均有统计学意义(P < 0.05~P < 0.01)。 结论 IVF-ET单侧输卵管切除会对AMH及卵巢功能产生一定影响,但对妊娠结局无明显改变。 Abstract:Objective To study the effects of in vitro fertilization-embryo transfer(IVF-ET) unilateral salpingectomy on the serum levels of anti-Müllerian hormone(AMH) and ovarian function. Methods A total of 200 patients with IVF-ET were divided into group A(70 cases treated with bilateral resection), group B(70 cases treated with unilateral resection), and group C(60 cases without resection) according to the method of salpingectomy.The AMH level and ovarian function on injection day, bilateral ovarian sinus follicles(AFC), use time and dosage of gonadotropin(Gn), number of eggs taken, effective embryos, high-quality embryos, total number of pregnancy, abortion, premature delivery and term delivery were compared among the three groups. Results The levels of AMH, luteinizing hormone and estradiol in group A were significantly lower than those in group B and group C, the levels of follicle stimulating hormone and progesterone in group A were significantly higher than those in group B and group C, and the AMH level in group B was significantly lower than that in group C(P < 0.05 to P < 0.01).The bilateral AFC in group A was significantly lower than that in group B and group C, the Gn dosage in group A was significantly higher than that in group B and group C, and the Gn dosage in group B was significantly higher than that in group C(P < 0.05 to P < 0.01).There was no statistical significance in the number of eggs taken among the three groups(P>0.05).The number of effective embryos and high-quality embryos in group A were significantly lower than that in group B and group C (P < 0.05).The abortion rate in group A was significantly higher than that in group C, and the rate of full-term delivery in group A was significantly lower than that in group B and group C(P < 0.05 to P < 0.01). Conclusions The IVF-ET unilateral salpingectomy can have a certain impact on the AMH level and ovarian function, but there was no significant change in pregnancy outcome. -
表 1 3组AMH和卵巢功能比较(x±s)
分组 n AMH/(ng/mL) FSH/(U/L) LH/(U/L) E2/(pg/mL) P/(nmol/L) A组 70 2.98±0.53 7.46±1.25 3.46±0.78 41.31±4.72 3.84±0.77 B组 70 3.82±0.65** 6.92±1.20** 3.97±0.83** 45.27±6.08** 3.22±0.71** C组 70 4.64±0.79**## 6.87±1.09* 4.05±0.88** 46.16±6.37** 3.05±0.60** F — 103.02 5.15 10.07 13.60 23.50 P — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 MS组内 — 0.433 1.408 0.686 32.903 0.492 q检验:与A组比较*P < 0.05,**P < 0.01;与B组比较##P < 0.01 表 2 3组AFC和Gn使用时间、Gn用量比较(x±s)
分组 n 双侧AFC/个 Gn使用时间/d Gn用量/U A组 70 10.43±2.17 12.58±2.36 3567.38±384.69 B组 70 13.26±3.25** 11.72±2.20* 2845.72±290.45** C组 70 14.05±3.59** 10.69±1.87**## 2709.50±278.93**# F — 26.31 11.90 136.62 P — < 0.01 < 0.01 < 0.01 MS组内 — 9.209 4.851 104 681.721 q检验:与A组比较*P < 0.05,**P < 0.01;与B组比较#P < 0.05,##P < 0.01 表 3 3组取卵数、有效胚胎、优质胚胎比较(x±s;个)
分组 n 取卵数 有效胚胎 优质胚胎 A组 70 14.02±3.15 8.68±1.24 4.03±0.79 B组 70 14.21±3.22 10.90±1.82** 5.86±1.12** C组 70 14.35±3.30 11.34±2.27** 6.18±1.30** F — 0.17 42.17 77.86 P — >0.05 < 0.01 < 0.01 MS组内 — 10.368 3.242 1.164 q检验:与A组比较**P < 0.01 表 4 3组妊娠结局比较[n;百分率(%)]
分组 n 总妊娠数 流产 早产 足月分娩 A组 70 52(74.29) 14(26.92) 8(11.43) 30(57.69) B组 70 61(87.14) 6(9.84) 5(8.20) 50(81.97)** C组 70 53(88.33) 4(7.55)* 3(5.66) 46(86.79)** χ2 — 5.83 6.64 1.92 19.13 P — >0.05 < 0.05 >0.05 < 0.01 q检验:与A组比较*P < 0.05,**P < 0.01 -
[1] 王芹, 李颖, 梁毓, 等. 不同预处理方案对卵巢储备功能下降病人IVF-ET结局的影响[J]. 北京医学, 2017, 39(11): 1088. [2] HUNTER P. The long-term health risks of ART: Epidemiological data and research on animals indicate that in vitro fertilization might create health problems later in life[J]. EMBO Rep, 2017, 18(7): 1061. doi: 10.15252/embr.201744479 [3] 陈明高, 王丽华, 张炎, 等. 输卵管积水不同处理方式对体外受精-胚胎移植结局的影响[J]. 介入放射学杂志, 2018, 27(12): 1173. doi: 10.3969/j.issn.1008-794X.2018.12.013 [4] 张焕焕, 舒静. 血清抗苗勒管激素水平与IVF-ET助孕结局的关系[J]. 生殖医学杂志, 2018, 27(12): 1238. doi: 10.3969/j.issn.1004-3845.2018.12.014 [5] SEYER-HANSEN M, EGEKVIST A, FORMAN A, et al. Risk of bowel obstruction during in vitro fertilization treatment of patients with deep infiltrating endometriosis[J]. Acta Obstet Gynecol Scand, 2018, 97(1): 47. doi: 10.1111/aogs.13253 [6] 赵雪含, 吴庚香, 杨菁. 高孕激素状态下促排卵方案中胚胎质量影响因素分析[J]. 生殖医学杂志, 2019, 28(6): 583. doi: 10.3969/j.issn.1004-3845.2019.06.001 [7] 李凤云, 刘红艳, 荣燕. 甲氨蝶呤药物治疗与腹腔镜下输卵管切除与否治疗输卵管妊娠的疗效对比[J]. 医学临床研究, 2018, 35(7): 1369. doi: 10.3969/j.issn.1671-7171.2018.07.042 [8] 江元元, 徐望明, 郭静秋, 等. 输卵管切除对年轻女性AMH及IVF-ET结局的影响[J]. 中国优生与遗传杂志, 2018, 26(2): 108. [9] 李惠敏, 吴惠华, 孟庆霞, 等. 抗苗勒管激素在IVF治疗多囊卵巢综合征病人中的应用价值探讨[J]. 南京师大学报(自然科学版), 2018, 41(1): 88. doi: 10.3969/j.issn.1001-4616.2018.01.016 [10] 邹闻达, 刘自卫, 张娟. 输卵管积水不同处理对体外受精-胚胎移植结局的影响[J]. 生殖医学杂志, 2019, 28(10): 1184. doi: 10.3969/j.issn.1004-3845.2019.10.016 [11] 冯军艳, 郑兴邦, 于晓明, 等. 输卵管Ⅲ期损伤保留输卵管的手术方式对体外受精-胚胎移植妊娠结局的影响[J]. 中国妇产科临床杂志, 2018, 19(4): 299. [12] 潘卓, 苏卿, 苏晶晶. 单侧输卵管切除术对输卵管妊娠病人卵巢储备功能及生育功能的影响[J]. 中国医药导报, 2018, 15(24): 92. [13] CHEN WY, DU YQ, GUAN X, et al. Effect of GnRHR polymorphisms on in vitro fertilization and embryo transfer in patients with polycystic ovary syndrome[J]. J Human Genet, 2017, 62(12): 1065. doi: 10.1038/jhg.2017.85 [14] 张莹莹, 杨洁, 肖国宏, 等. 输卵管切除术对IVF-ET促排卵中卵巢反应性的影响[J]. 生殖医学杂志, 2019, 28(3): 12. [15] 李浩僡, 郝佳渊, 廖源. 既往输卵管手术史对IVF-ET不孕症病人卵巢反应性和妊娠结局的影响[J]. 中国性科学, 2018, 27(9): 65. doi: 10.3969/j.issn.1672-1993.2018.09.020 [16] 米灵, 邵红, 王书敏, 等. 认知行为干预联合肌肉放松训练对IVF-ET病人心理应激及幸福感的影响[J]. 蚌埠医学院学报, 2020, 45(3): 134.