Analysis Of The Pregancy Outcome And The Related Influential Factors Of Laparoscopy And Hysteroscopy Combined With Assisted Reproductive Techniques On The Treatment Of Tubal Factor Infertility

Background:Tubal infertility (Tubal factor infertility, TFI), is due to various factors forming the wall of the oviduct epithelial ciliary muscle contraction and motility or tubal adhesions, water and obstruction, causing tubal end pickup and delivery fertilized egg loss of function of implantation into the uterine cavity, leading to female infertility. In recent years, on the one hand due to the delayed marriage and childbearing, the artificial increase in the number of abortions and sexually transmitted diseases increase the incidence of tubal infertility tended to increase; partly because of the popularity of laparoscopic techniques in the application of female infertility, tubal factor in the importance of female reproductive function is more and more attentioned. Have a high incidence of tubal infertility, cause diverse, poor efficacy characteristics, which seriously affect the patient ’s health and family harmony.Currently, tubal infertility treatment methods are commonly used in tubal surgery, hysterosalpingography, hysteroscopy surgery such as intubation through the liquid. Currently laparoscopy and hysteroscopy surgery are considered the gold standard for tubal infertility. Differences in their therapeutic effects in patients with case selection and pelvic adhesions, tubal disease, tubal patency, which are closely related. The IVF-ET appears to solve the sperm-egg binding in patients with tubal infertility disorder problems, and a higher pregnancy rate, but the cost is higher. Currently still no uniform standard clinical treatment of tubal infertility criteria.In this study, a retrospective analysis of laparoscopy combined with assisted reproductive technology treatment of tubal infertility pregnancy outcomes and related factors, to explore ways to improve pregnancy outcomes of tubal infertility, to provide reference for clinical treatment.Objective：By analyzing the combined laparoscopy and assisted reproductive technology treatment of tubal infertility patients, to explore its natural pregnancy rate after surgery, postoperative best time to pregnancy, analyze the relationship between various factors and pregnancy rates after surgery undergoing assisted reproduction best time. comprehensiving overall situation of patients with tubal infertility to guide patients to master the best time to pregnancy and to get the highest pregnancy rate.Subjects and Methods:1Subjects We studied from January2010to December2010during the Third AffiliatedHospital of Zhengzhou University,426cases tubal infertility patients,hospitalized laparoscopic and hysteroscopy surgery,207cases meet the standards, during follow-up, lost21cases,186cases were followed, including five cases of ipsilateral fallopian tubes removed because of tubal pregnancy, a total of367tubal included in this study, which included73cases of primary infertility, secondary infertility113cases.2MethodsWe used the Telephone to follow-up pregnancy after6months,12months,18 months; according to whether natural pregnancy,we divided into natural pregancy group and non-pregnancy of natural group. After6months, in non-pregnancy of natural group,54patients accepted assisted reproductive techiques:in vitro fertilization and embryo transfer (IVF-ET), we use the telephone to follow-up whether to conceive.According to the pregnancy of IVF-ET,we divided into IVF pregnancy group and non-pregnant of IVF group.All patients were followed up to investigate general information such as age, duration of infertility, infertility category; previous surgery in patients such as history of abortion, pelvic surgery, tubal pregnancy history; Intraoperative situation including degree pelvic adhesions, degree hydrosalpinx(by visual inspection), intraoperative tubal patency after treatment.3Statistical MethodsEntry Excel sheet after the relevant variables to be encoded. Using SPSS17.0statistical software to analyze data, test level α=0.05, comparing the base case with χ2test for independent samples T-test. The relevant factors affecting the outcome of pregnancy first single factor Logistic regression analysis, statistical significance (P <0.1) of the introduction of multi-factor Logistic regression analysis.Results:1Pregnancy:186patients after laparoscopy total natural pregnancy69cases, total natural pregnancy rate was37.10%(69/186); laparoscopy surgery within June55cases of natural pregnancy, natural pregnancy rate was29.57%(55/186); surgery between July to December,12cases of spontaneous pregnancy, within0-12months after the laparoscopy,the natural pregnancy rate was36.02%(55+12/186);Natural pregnancy2cases after December, during0-18months total natural pregnancy rate was37.10%(55+12+2/186); laparoscopy after6months,54patients accepted IVF-ET, of which28cases of pregnancy, IVF pregnancy rate was51.85%(28/54).2Laparoscopy surgery natural pregnancy-related factors in the analysis:General information: univariate and multivariate analysis showed: Age P>0.05, regression coefficient β is-0.125; duration of infertility P<0.05, regression coefficient β is-0.281; infertility category P>0.05, regression coefficient β is-0.4; duration of infertility can be considered negative factors affecting natural pregnancy rates after laparoscopy, duration of infertility growth, natural pregnancy rate declined. Age and Infertility category are not a natural pregnancy affecting Factors.Previous surgery: univariate and multivariate analysis showed: abortion history P>0.1, the regression coefficient β is-0.229; pelvic surgery P>0.1, the regression coefficient β is-0.394; tubal pregnancy history P <0.05, regression coefficient β is-1.871, chi-square analysis χ2was0.747, P=0.262>0.05, the difference was not statistically significant; therefore history of abortion, pelvic surgery, history of tubal pregnancy are not affected the rate of natural pregnancy.Intraoperative situation: univariate and multivariate analysis showed that: pelvic adhesions P <0.05, regression coefficient β is-0.98, chi-square analysis χ2is3.22, P <0.05, significant difference; degree hydrosalpinx P <0.05, The regression coefficient β is-0.85, chi-square analysis χ2is0.27, P <0.05, significant difference; tubal patency P <0.05, regression coefficient β is0.743, chi-square analysis χ2was4.947, P <0.05, there was statistically significant; pelvic adhesions can be considered the degree of tubal degree water is negatively related to natural factors affecting pregnancy rate, with the extent of pelvic adhesions and hydrosalpinx severity of natural pregnancy rate decreased. Tubal patency is positively related to factors affecting natural pregnancy rate. Bilateral tubal patency pregnancy rate is higher than the one-sided nature of the natural smooth pregnancy.To sum up: duration of infertility, pelvic adhesions extent, degree hydrosalpinx are negatively correlated factors affecting natural pregnancy rates after laparoscopy, tubal patency is positively related factors.3Correlation analysis of natural pregnancy after laparoscopy factors of failure of IVF pregnancy ratesGeneral information: univariate and multivariate analysis showed: Age P <0.05, regression coefficient β is-0.473; duration of infertility P>0.05, regression coefficient β is-0.042; infertility category P>0.05, regression coefficient β is-0.048; may be considered negative factors influencing the age pregnancy rate of IVF, with age, IVF pregnancy rates declined; duration of infertility and infertility categories are not relevant factors affecting IVF pregnancy rates.Previous surgery: univariate and multivariate analysis showed: abortion history P>0.1, the regression coefficient β is-0.336; pelvic surgery P>0.1, the regression coefficient β is-0.357; tubal pregnancy history P>0.1, the regression coefficients β is-0.077; therefore history of induced abortion, pelvic surgery, tubal pregnancy history is not a factor affecting IVF pregnancy rate.Intraoperative situation: univariate and multivariate analysis showed that: pelvic adhesions P>0.05, regression coefficient β is-0.457; the degree of hydrosalpinx P <0.05, regression coefficient β-0.95; tubal patency P>0.05, regression coefficient β is-0.223; may consider the extent of pelvic adhesions, tubal patency is not water related factors affecting pregnancy rates in IVF, tubal factor is inversely related to the degree of water affect IVF pregnancy. That is, with the severity of hydrosalpinx, IVF pregnancy rates decreased.To sum up:age and the degree of hydrosalpinx are negatively related to tubal factor in spontaneous pregnancy after IVF pregnancy failures.Conclusion:1.The highest natural pregnancy rate get in patients within laparoscopy and hysteroscopy6months later.guiding patients to pregnancy as soon as possible to get the best pregnancy outcome.2.Shorter duration of infertility, no pelvic adhesions or lesser extent, no hydrosalpinx or lesser extent, patients have a high pregnancy rate after laparoscopic and hysteroscoic surgery, which can expect a natural pregnancy；Longer duration of infertility, pelvic adhesions severe, severe hydrosalpinx, patients,which have a low pregnancy rate,should receive IVF-ET treatment as soon as possible,after half of year of laparoscopic and hysteroscoic surgery natural pregnancy failure.3. older, patients with severe hydrosalpinx,which have a low pregnancy rate after laparoscopic surgery and IVF-ET treatment,should accept IVF-ET treatment directly.