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目的:探讨体外受精-胚胎移植后异位妊娠的发生率、高危因素及处理方式。方法:回顾性分析2009年2月～2011年2月接受IVF/ICSI治疗后发生异位妊娠的患者20例,并随机选取IVF/ICSI治疗后正常宫内妊娠100例作为正常对照。结果:IVF/ICSI共治疗1 434个周期,临床妊娠645例,临床妊娠率为44.98%(645/1 434),其中发生异位妊娠20例,发生率为3.10%(20/645),其中宫内外同时妊娠2例,输卵管间质部妊娠2例,宫角妊娠1例。20例异位妊娠的不孕原因中,有16例为输卵管因素,3例为多囊卵巢综合征,3例有子宫内膜息肉,4例为子宫内膜异位症,8例有既往异位妊娠史,7例有流产史。两组患者的年龄、不孕年限、不孕类型、体重指数(BMI)、助孕方式、移植胚胎类型、人绒毛膜促性腺激素注射日雌二醇及黄体生成素水平、子宫内膜厚度等比较差异均无统计学意义(P>0.05),而人绒毛膜促性腺激素注射日孕激素水平、雌二醇/孕激素比值的差异有统计学意义(P<0.05)。结论:输卵管病变和盆腔炎是辅助生殖术后异位妊娠发生的高危因素,阴道超声检查结合血β-HCG值测定是最有效的诊断措施,腹腔镜下输卵管切除术是目前治疗异位妊娠的较好方法。
Objective: To investigate the incidence, risk factors and management of ectopic pregnancy after in vitro fertilization and embryo transfer. Methods: Twenty patients with ectopic pregnancy after IVF / ICSI treatment from February 2009 to February 2011 were retrospectively analyzed. 100 cases of normal intrauterine pregnancy after IVF / ICSI treatment were selected randomly as the normal control. Results: A total of 1 434 cycles of IVF / ICSI were observed. Clinical pregnancy was 645 cases with clinical pregnancy rate of 44.98% (645/1 434). Ectopic pregnancy occurred in 20 cases with a rate of 3.10% (20/645) Intrauterine and external pregnancy in 2 cases, tubal interstitial pregnancy in 2 cases, 1 case of cornual pregnancy. In 20 cases of ectopic pregnancy causes of infertility, there are 16 cases of tubal factors, 3 cases of polycystic ovary syndrome, 3 cases of endometrial polyps, 4 cases of endometriosis, 8 cases of past differences Pregnancy history, 7 cases of abortion history. Age, duration of infertility, type of infertility, body mass index (BMI), mode of pregnancy, type of embryo transfer, levels of estradiol and luteinizing hormone on human chorionic gonadotrophin injection, endometrial thickness, etc. (P> 0.05). However, the difference of progesterone level and estradiol / progesterone ratio on the day of human chorionic gonadotropin injection was statistically significant (P <0.05). Conclusions: Tubal lesions and pelvic inflammatory disease are risk factors for ectopic pregnancy after assisted reproductive surgery. Vaginal ultrasonography combined with serum β-HCG determination is the most effective diagnostic measure. Laparoscopic tubal resection is currently the treatment of ectopic pregnancy Better way.