卵巢内异囊肿剥除术后不同时间行IVF结局分析
发布时间：2018-10-29 16:34
【摘要】：研究目的：分析卵巢内异囊肿剥除术后不同时间进行体外受精-胚胎移植(In vitrofertilization--embryo transfer,IVF-ET)的结局,比较不同促排卵方案在其中的作用,为卵巢内异囊肿剥除术后患者选择IVF-ET时机以及促排卵方案提供依据。研究方法：回顾性分析2010年1月1日至2014年12月31日于浙江大学附属妇产科医院生殖内科进行IVF-ET的297例有卵巢内异囊肿剥除手术史的中重度内异不孕患者的临床、实验室及随访资料。按取卵手术与囊肿剥除术间隔时间分为五组,分别为3个月内、4-6个月、7-12个月、13-24个月、24个月后。统计比较各分组的基本情况,以及IVF-ET结局指标。按患者使用的控制性超促排卵方案分为长方案组和超长方案组,比较两种方案对IVF-ET结局的影响,并分析两种促排卵方案在各时间分组中对IVF-ET结局的影响。研究结果：卵巢内异囊肿剥除术后4-6个月行取卵手术患者在胚胎植入率,临床妊娠率和活产率上都高于其他各组,但在统计学上无显著差异。术后6个月内行取卵手术患者的胚胎植入率,临床妊娠率,活产率都显著高于6个月后。超长方案组的胚胎植入率(38.64%)显著高于长方案组(28.25%)。使用超长方案患者的临床妊娠率和活产率也高于使用长方案,但统计学上无显著差异。使用长方案的患者中,卵巢内异囊肿剥除术后3个月内行取卵手术的6名患者均未实现临床妊娠；4-6个月组的临床妊娠率和活产率最高,分别为57.69%和50.00%；6个月后随着取卵手术与囊肿剥除术间隔时间延长,临床妊娠率和活产率呈下降趋势。使用超长方案的患者中,不同时间分组的临床妊娠率和活产率未见显著差异。卵巢内异囊肿剥除术24个月后行取卵手术患者中,超长方案组的临床妊娠率为46.34%,显著高于长方案组的22.86%(p=0.033)；超长方案组的活产率43.90%也显著高于长方案组17.14%(p=0.012)。结论：对重度内异不孕患者来说,术后6个月内进入IVF-ET周期更能获益,4-6个月可能是卵巢内异囊肿剥除术与IVF-ET的最佳间隔时间。而对卵巢内异囊肿剥除术后2年以上的患者,可使用超长方案促排卵来增加临床妊娠成功率。
[Abstract]:Objective: to analyze the outcome of in vitro fertilization and embryo transfer (In vitrofertilization--embryo transfer,IVF-ET) at different time after excision of ovarian heterocyst, and to compare the effects of different ovulation promotion protocols. To provide evidence for the choice of IVF-ET timing and ovulation promotion in patients with ovarian endometriosis after excision. Methods: from January 1, 2010 to December 31, 2014, we retrospectively analyzed the clinical features of 297 cases of moderate and severe infertility with history of ovarian cysts excision in Department of Reproductive Medicine, Department of Obstetrics and Gynecology, affiliated to Zhejiang University, from January 1, 2010 to December 31, 2014. Laboratory and follow-up data. They were divided into five groups according to the interval between oocyte extraction and cystectomy, which were within 3 months, 4 to 6 months, 7 to 12 months, 13 to 24 months and 24 months later respectively. Statistical comparison of the basic situation of each group, as well as IVF-ET outcome indicators. The patients were divided into two groups according to the controlled hyperstimulation of ovulation. The effects of the two schemes on the outcome of IVF-ET were compared, and the effects of the two protocols on the outcome of IVF-ET were analyzed in each time group. Results: the embryo implantation rate, clinical pregnancy rate and live delivery rate were higher in patients undergoing oocyte extraction 4-6 months after excision of ovarian cyst than in other groups, but there was no significant difference in statistics. The embryo implantation rate, clinical pregnancy rate and live delivery rate were significantly higher in patients undergoing oocyte extraction within 6 months after operation than those after 6 months. The embryo implantation rate (38.64%) was significantly higher in the super-long group (28.25%) than in the long group (28.25%). The clinical pregnancy rate and live delivery rate were also higher in patients with long term regimen than in those with long term regimen, but there was no significant difference in statistics. The clinical pregnancy rate and live delivery rate were 57.69% and 50.005% in the 4-6 months group, respectively, among the 6 patients who had undergone oocyte extraction within 3 months after ovarian cyst excision, and the clinical pregnancy rate and the live delivery rate were the highest in the 4-6 month group, and the clinical pregnancy rate was 57.69% in the 4-6 month group, and 57.69% in the 4-6 month group. After 6 months, the clinical pregnancy rate and live delivery rate decreased with the prolongation of the interval between oocyte extraction and cystectomy. There was no significant difference in clinical pregnancy rate and live delivery rate between different time groups in patients with super long regimens. The clinical pregnancy rate in the super-long group was 46.34, which was significantly higher than that in the long regimen group (22.86%) (p0.033). The live birth rate of the super-long regimen group (43.90%) was significantly higher than that of the long plan group (17.14%) (p0. 012). Conclusion: for the patients with severe endometriosis, it is more beneficial to enter the IVF-ET cycle within 6 months after operation, and 4-6 months may be the best interval between the excision of ovarian heterocyst and IVF-ET. For the patients with ovarian endometriosis more than 2 years after excision, ovulation promotion can be used to increase the clinical pregnancy success rate.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R713.6;R714.8
本文编号：2298227
[Abstract]:Objective: to analyze the outcome of in vitro fertilization and embryo transfer (In vitrofertilization--embryo transfer,IVF-ET) at different time after excision of ovarian heterocyst, and to compare the effects of different ovulation promotion protocols. To provide evidence for the choice of IVF-ET timing and ovulation promotion in patients with ovarian endometriosis after excision. Methods: from January 1, 2010 to December 31, 2014, we retrospectively analyzed the clinical features of 297 cases of moderate and severe infertility with history of ovarian cysts excision in Department of Reproductive Medicine, Department of Obstetrics and Gynecology, affiliated to Zhejiang University, from January 1, 2010 to December 31, 2014. Laboratory and follow-up data. They were divided into five groups according to the interval between oocyte extraction and cystectomy, which were within 3 months, 4 to 6 months, 7 to 12 months, 13 to 24 months and 24 months later respectively. Statistical comparison of the basic situation of each group, as well as IVF-ET outcome indicators. The patients were divided into two groups according to the controlled hyperstimulation of ovulation. The effects of the two schemes on the outcome of IVF-ET were compared, and the effects of the two protocols on the outcome of IVF-ET were analyzed in each time group. Results: the embryo implantation rate, clinical pregnancy rate and live delivery rate were higher in patients undergoing oocyte extraction 4-6 months after excision of ovarian cyst than in other groups, but there was no significant difference in statistics. The embryo implantation rate, clinical pregnancy rate and live delivery rate were significantly higher in patients undergoing oocyte extraction within 6 months after operation than those after 6 months. The embryo implantation rate (38.64%) was significantly higher in the super-long group (28.25%) than in the long group (28.25%). The clinical pregnancy rate and live delivery rate were also higher in patients with long term regimen than in those with long term regimen, but there was no significant difference in statistics. The clinical pregnancy rate and live delivery rate were 57.69% and 50.005% in the 4-6 months group, respectively, among the 6 patients who had undergone oocyte extraction within 3 months after ovarian cyst excision, and the clinical pregnancy rate and the live delivery rate were the highest in the 4-6 month group, and the clinical pregnancy rate was 57.69% in the 4-6 month group, and 57.69% in the 4-6 month group. After 6 months, the clinical pregnancy rate and live delivery rate decreased with the prolongation of the interval between oocyte extraction and cystectomy. There was no significant difference in clinical pregnancy rate and live delivery rate between different time groups in patients with super long regimens. The clinical pregnancy rate in the super-long group was 46.34, which was significantly higher than that in the long regimen group (22.86%) (p0.033). The live birth rate of the super-long regimen group (43.90%) was significantly higher than that of the long plan group (17.14%) (p0. 012). Conclusion: for the patients with severe endometriosis, it is more beneficial to enter the IVF-ET cycle within 6 months after operation, and 4-6 months may be the best interval between the excision of ovarian heterocyst and IVF-ET. For the patients with ovarian endometriosis more than 2 years after excision, ovulation promotion can be used to increase the clinical pregnancy success rate.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R713.6;R714.8
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