Diminished pregnancy rates in endometriosis due to impaired uterotubal transport assessed by hysterosalpingoscintigraphy
Diminished pregnancy rates in endometriosis due to impaired uterotubal transport assessed by hysterosalpingoscintigraphy
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DOI：
10.1111/j.1471-0528.2005.00676.x
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发表时间：
2005-10-01
影响因子：
5.8
通讯作者：
Kaufmann, M
中科院分区：
文献类型：
--
作者：
Kissler, S;Hamscho, N;Kaufmann, M
目的应用子宫输卵管核素显像(HSSG)观察子宫内膜异位症患者和非子宫内膜异位症患者子宫输卵管的运输情况。设计前瞻性观察研究，设大学医院妇产科生殖内分泌科350个体外受精(IVF)/卵胞浆内单精子注射(ICSI)周期，400个/年宫腔内授精(IUI)周期。以22例患有男性因素不育症的女性为对照。随后，患者接受了四个周期的定时性交(TI)或IUI以实现怀孕。结果子宫内膜异位症患者(I组)的生理输卵管运输功能明显降低：20例(36%)患者有单侧或双侧子宫输卵管运输，36例(%)有优势卵泡对侧的病理性子宫输卵管运输或完全丧失子宫输卵管运输能力(阴性)。对照组(II组)输卵管运输功能有显著差异：15例(68%)显示单侧和双侧输卵管，5例(22%)显示对侧输卵管，2例(10%)HSSG阴性(P=0.01)。观察妊娠23例(妊娠率：29%)。14例具有输卵管单侧或双侧输卵管输送功能的妇女中，有11例(79%)通过经皮输卵管或输卵管内输精管妊娠。在9例输卵管输送失败的患者中，有7例(78%)在精液参数可接受的情况下通过IVF/ICSI获得妊娠(P=0.01)。结论子宫内膜异位症与生理性子宫输卵管输送能力降低有关。这导致了妊娠率的降低，即使在有正常精子症伴侣的女性中也是如此。因此，即使在输卵管通畅或精液质量正常的情况下，也可能需要进行IVF/ICSI。
Objective To investigate uterotubal transport by means of hysterosalpingoscintigraphy (HSSG) in women with and without endometriosis.Design A prospective observational study.Setting University Hospital, Department of Obstetrics and Gynaecology, Division of Reproductive Medicine and Gynaecologic Endocrinology with 350 in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) cycles and 400 intrauterine insemination (IUI) cycles/year.Population Cases included 56 infertile women with laparoscopic proven endometriosis and patent fallopian tubes. Twenty-two women with partners suffering from male factor infertility served as controls.Methods A diagnostic cycle incorporating HSSG was performed. Subsequently, patients underwent either four cycles of timed intercourse (TI) or IUI in order to achieve pregnancy. If pregnancy did not occur, IVF or ICSI was performed.Main outcome measures Evaluation of uterotubal transport capacity in women with endometriosis and healthy controls.Results Patients suffering from endometriosis (group I) showed a significant reduction in physiologic uterotubal transport function: While 20 patients (36%) had ipsi- or bilateral uterotubal transport, there was pathological uterotubal transport contralateral to the dominant follicle or a complete failure of transport capacity (negative HSSG) in 36 patients (64%). In the controls (group II), transport function was significantly different: 15 of 22 patients (68%) revealed ipsi- and bilateral tubal demonstration, while 5 patients (22%) showed contralateral transport and 2 patients (10%) showed negative HSSG (P= 0.01). Twenty-three pregnancies were observed (pregnancy rate: 29%). Eleven out of 14 (79%) women with ipsi- or bilateral tubal transport function fell pregnant by means of TI or IUI. In seven of nine patients (78%) with a failure in tubal transport, pregnancy was achieved by IVF/ICSI, despite acceptable semen parameters (P= 0.01).Conclusions Endometriosis is significantly associated with a reduction in physiologic uterotubal transport capacity compared with controls. This resulted in diminished pregnancy rates even in women with normozoospermic partners. Therefore, IVF/ICSI may be required even when fallopian tubes are patent or semen quality is normal.