Ovarian response to gonadotropins after laparoscopic salpingectomy or the division of fallopian tubes for hydrosalpinges
Ovarian response to gonadotropins after laparoscopic salpingectomy or the division of fallopian tubes for hydrosalpinges
复制标题
DOI：
10.1016/j.fertnstert.2005.10.036
复制
发表时间：
2006-05-01
影响因子：
6.7
通讯作者：
Lieberman, Brian A.
中科院分区：
文献类型：
--
作者：
Gelbaya, Tarek A.;Nardo, Luciano G.;Lieberman, Brian A.
目的：比较预防性腹腔镜输卵管切除术与输卵管分割术对接受IVF.Design：回顾性研究的女性卵巢对促性腺激素的反应的影响：国家卫生服务中心的三级生殖医学转诊中心。65名患有输卵管积水的妇女接受了输卵管切除术（n = 40，A组）或近端输卵管分离B组25例，对照组为输卵管疾病但无输卵管积水者（n = 103，C组）。干预：预防性腹腔镜输卵管切除术或输卵管近端离断术和促性腺激素卵巢刺激用于IVF。主要结局措施：手术前和手术后3个月但在卵巢刺激前的第2天血清FSH水平，卵巢反应评估为给予的hMG总剂量，血清E，刺激第3天和第8天以及hCG注射当天的浓度，卵泡数，以及获得和受精的卵母细胞数。在A组中，与术前相比，术后基线FSH水平显著升高。A组术后FSH浓度显著高于B组。A组卵泡数（15-20 mm）明显低于B组和C组。刺激第8天，A组血清雌二醇水平低于B组，注射hCG当天，A组血清雌二醇水平明显低于B组和C组。与B组相比，A组每个周期获得的卵母细胞数显著减少。三组间妊娠率和流产率无显著差异。结论：这些研究结果表明，输卵管积水妇女预防性输卵管切除术可能会损害卵巢对刺激的反应，而不影响妊娠率。建议进行随机对照试验，以确定IVF前输卵管积水最合适的腹腔镜手术。
Objective: To compare the effect of prophylactic laparoscopic salpingectomy versus division of the fallopian tubes on ovarian response to gonadotropins in women undergoing IVF.Design: Retrospective study.Setting: National Health Service-based tertiary referral center for reproductive medicine.Patient(s): One hundred sixty-eight women with tubal factor infertility. Sixty-five women with hydrosalpinges had either salpingectomy (n = 40, group A) or proximal tubal division (n = 25, group B), while the remaining women with tubal disease but without hydrosalpinges acted as the control group (n = 103, group C).Intervention(s): Prophylactic laparoscopic salpingectomy or proximal division of the fallopian tubes and ovarian Stimulation with gonadotropins for IVF.Main Outcome Measure(s): Day 2 serum FSH levels before surgery and 3 months after surgery but before ovarian stimulation, ovarian response assessed as total dose of hMG administered, serum E, concentrations on day 3 and day 8 of stimulation and on the day of hCG injection, number of follicles, and number of oocytes retrieved and fertilized.Result(s): In group A, baseline FSH levels were significantly raised after surgery compared with before surgery. Postsurgery FSH concentrations were significantly higher in group A compared with group B. The number of follicles (15-20 mm) was significantly lower in group A compared with group B and group C. The serum E, levels on day 8 Of stimulation were lower in group A compared with group B, and on the day of hCG injection it was significantly reduced in group A compared with groups B and C. The number of oocytes retrieved per cycle was significantly lower in group A compared with group B. There were no significant differences in pregnancy rates and miscarriage rates among the three groups.Conclusion(s): These findings suggest that prophylactic salpingectomy in women with hydrosalpinx may compromise ovarian response to stimulation without affecting pregnancy rates. A randomized control trial is recommended to determine the most appropriate laparoscopic procedure in the management of hydrosalpinx before IVF.