摘要
目的探讨早期妇科肿瘤术后不孕症患者与无手术史不孕症患者行体外受精-胚胎移植(IVF-ET)治疗的实验室和临床结局差异。方法收集2013年8月至2019年8月在同济大学附属同济医院行IVF治疗的早期妇科肿瘤保留生育功能术后患者5例作为肿瘤术后组,并选择同时期年龄、体重指数(BMI)匹配的10例无手术史不孕症患者作为对照组,比较两组患者的基本资料、促排卵和胚胎发育情况及临床结局。并将肿瘤术后组中成功分娩的4例患者分为宫颈癌术后和卵巢肿瘤术后两个亚组,与对照组的母胎预后情况进行比较分析。结果肿瘤术后组和对照组患者的年龄、BMI、不孕年限、基础性激素水平、受精率、优质胚胎率、移植方式、每周期平均移植胚胎数、妊娠率、活产率、分娩方式、产后哺乳、转经及随访时间等比较均无统计学差异(P>0.05)。肿瘤术后组的窦卵泡数[(4.4±1.9)vs.(15.3±3.6)枚]、Gn天数[(5.2±5.0)vs.(12.5±2.1)d]、Gn总量[(1150±1310)vs.(3210±1554)U]、获卵数[(4.0±5.1)vs.(15.0±3.1)枚]、可用胚胎数[(2.9±3.4)vs.(9.0±2.6)枚]、优质胚胎数[(2.1±3.0)vs.(6.5±2.3)枚]、分娩孕周[(35.7±2.0)vs.(38.6±2.8)周]和单胎出生体重[(2800±707)vs.(3166±856)g]均显著低于对照组(P<0.05)。与对照组比较,宫颈癌术后亚组的分娩孕周[(34.0±0.0)vs.(38.6±2.8)周]、哺乳时间[(0.5±0.7)vs.(8.7±4.6)月]和转经时间[(4.0±0.0)vs.(10.4±3.4)月]显著降低,早产率(100.0%vs.30.8%)则显著升高(P<0.05)。结论早期妇科肿瘤保留生育功能术后合并不孕症患者行IVF助孕治疗有效且安全。妇科肿瘤术后卵巢功能受损的年轻患者应注重生育力的保护。宫颈癌术后患者早产率高,孕期应加强监护和管理,以期改善母胎预后。
Objective:To investigate the differences in laboratory and clinical outcomes following IVF-ET treatment between infertile women after early gynecologic tumor surgery and those with no history of surgery.Methods:The data of 5 patients with early gynecologic tumors after fertility preservation surgery who underwent IVF treatment in the Reproductive Medicine Center of Tongji Hospital of Tongji University from August 2013 to August 2019 were retrospectively analyzed.Ten patients with no history of surgery matched by age and body mass index(BMI)at the same time were selected as control group.The basic characteristics,ovulation induction,embryo development and clinical outcomes of the two groups were compared.Four patients with successful delivery in the early gynecologic tumor group were divided into two subgroups:cervical cancer surgery group and ovarian tumor surgery group.The prognosis of the maternal fetus was compared with the control group.Results:There were no significant differences in age,BMI,infertility years,basic sex hormones levels,fertilization rate,good quality embryo rate,transplantation method,average number of embryos transfer per cycle,pregnancy rate,live birth rate,mode of delivery,breastfeeding,menses return and follow-up time(P>0.05).The number of antral follicles[(4.4±1.9)vs.(15.3±3.6)],Gn days[(5.2±5.0)vs.(12.5±2.1)days],total Gn doses[(1150±1310)vs.(3210±1554)U],the number of oocytes retrieved[(4.0±5.1)vs.(15.0±3.1)],the number of available embryos[(2.9±3.4)vs.(9.0±2.6)],the number of good quality embryos[(2.1±3.0)vs.(6.5±2.3)],the gestational weeks of delivery[(35.7±2.0)vs.(38.6±2.8)weeks],and the birth weight of single birth[(2800±707)vs.(3166±856)g]in the early gynecologic tumor group were significantly lower than those in the control group(all P<0.05).The gestational weeks of delivery[(34.0±0.0)vs.(38.6±2.8)weeks],breastfeeding time[(0.5±0.7)vs.(8.7±4.6)months]and menses return time[(4.0±0.0)vs.(10.4±3.4)months]were significantly shorter,and preterm birth rate(100.0%v
作者
李颖
纪亚忠
石礼红
LI Ying;JI Ya-zhong;SHI Li-hong(Reproductive Medical Center,Tongji Hospital of Tongji University,Shanghai 200065)
出处
《生殖医学杂志》
CAS
2020年第3期329-335,共7页
Journal of Reproductive Medicine
基金
同济大学“中央高校基本科研业务费”（22120180618）
上海市科委基金（18411964300）
关键词
早期妇科肿瘤
生育力保护
辅助生殖技术
妊娠结局
母胎预后
Early gynecological tumors
Fertility preservation
Assisted reproductive technology
Pregnancy outcome
Maternal fetal prognosis
