| BackgroundInfertility is the worldwide problem which influences men and women on both part of the physical and mental health.The world health organization lists infertility,cardiovascular disease and tumor as the three major disease effecting human life and health. Female infertility simply caused by fallopian tube lesions refers to tubal infertility.In recent years, with endoscopic technology continuing to mature, hysteroscope and laparoscope widely apply to the treatment of oviduct infertility.But viewing from the pregnancy outcome, there are still part of patients who can’t aquire satisfactory conclusion.In order to preferably understand the influence factors of the pregnancy rate, this topic will analyse the clinical data of oviduct infertility patients who had been treated by hysteroscope and laparoscope and follow-up the pregnancy outcome. ObjectiveTo explore the influence factors of pregnancy rate of tubal infertility patients who had been treated by hysteroscope and laparoscope,in order to improve the postoperative pregnancy rate.Materials and Methods1MaterialsThere are467cases of oviduct infertility patients who had been treated by hysteroscope and laparoscope,from zhengzhou university of the third affiliated hospital between June2009to December2009.It lefts186cases after screening.lt contains368fallopian tube (four patients have cut off their tubal because of ectopic pregnancy). All of them are between20and40years old,mean age(30.68±4.06)years old. The shortest duration for1year, the longest for15years.87patients had primary infertility and99had secondary infertility.2MethodsStep1:Clinical data of all patients were analyzed. List all kinds of factors that may affect pregnancy rate:bad history including pelvic surgery history, tubal pregnancy history, history of abortion; preoperative examination conditions such as hystero-salpingography (HSG) showing the tubal soft degree,Gynecological Sonography showing the pelvic cavity accumulates fluid amount;intraoperative including pelvic adhesion degree, hydrosalpinx diameter size,tubal unobstructed situation; postoperative pregnancy time.Step2:Follow-up:by phone method; time for postoperative1to24months;content for pregnancy or not, pregnancy time, uterine pregnancy or ectopic pregnancy, whether do other treatment or assisted reproductie technologies, etc.Step3:All patients were divided into two groups:pregnancy and not pregnancy according to the follow-up results. Make an analysis of the factors between these two groups,including single factor and multivariate analysis.3Statistical analysisStatistical analysis was performed by using SPSS10.0statistical software, measurement data use (x±s) said; the comparison of quantitative data by t-test, the comparison of qualitative material by Pearson chi-square test.These factors which were likely to affect the postoperative pregnancy rate were performed by the single factor analysis;and then these factors whose P≤0.1were taken into the logistic regression analysis (unconditional).The statistical significance in this study was α=0.05.Results1. Pregnancy rate:pregnancy rate of tubal infertility patients who had been treated by hysteroscope and laparoscope is49.40%,1years pregnancy rate40.36%(67/166),1-2years pregnancy rate15.15%(15/99); The number of pregnancy over time is reduced.2. Comparison of general material:general material including age infertility fixed number of year and infertility category (including primary and secondary infertility) were compared in pregnancy group and not pregnancy group. The average age of pregnancy group (30.36+4.22), not pregnancy group (30.98±3.94), age on two groups of comparison P=0.477; the average infertility fixed number of year of pregnancy group (2.82±1.88), not pregnancy group (3.60±2.98), infertility fixed number of year on two groups of comparison P=0.151; infertility category on two groups of comparison X2=1.126, P=0.132. The results suggested that general material on the two groups were comparable (P>0.05).3. Single factor analysis:①According to whether had a history of tubal pregnancy divided into two groups, pregnancy rate on two groups of comparisonX2=5.067, P=0.024, pregnancy rate of history of tubal pregnancy was34.15%, no history of tubal pregnancy was54.40%. The results suggested that the pregnancy rate of history of tubal pregnancy was lower than those without tubal pregnancy history (P<0.05).②According to preoperative HSG showing fallopian tube soft degree divided into fallopian tubal soft, owe soft, stiff three groups, pregnancy rate on three groups of comparison linear χ2=6.711, P=0.010; the pregnancy rate of tubal soft was58.43%, owe soft41.82%, stiff31.82%. The results suggested that with the decrease of tubal soft rate, the pregnancy rate in turn decrease (P<0.05).③According to the pelvic adhesion degree divided into pelvic mild adhesion, moderate adhesion, severe adhesion three groups, pregnancy rate on three groups of comparison linear χ2=20.449, P<0.001; the pregnancy rate of pelvic mild adhesion was64.44%, moderate adhesion38.78%, severe adhesion18.52%.The results suggested that with the increase of the pelvic adhesion degree, the pregnancy rate in turn decrease (P<0.05).④According to laparoscopic hydrosalpinx degree divided into hydrosalpinx diameter d≤3cm and d>3cm two groups, pregnancy rate on two groups of comparison χ2=11.796, P=0.001; the pregnancy rate of d≤3cm was48.72%, d>3cm12.82%. The results suggested that the pregnancy rate of hydrosalpinx d>3cm was lower than d≤3cm (P<0.05).Results showed that the above four factors were the influence factors of pregnancy rate of tubal infertility patients who had been treated by hysteroscope and laparoscope (P<0.05).⑤According to whether had a history of pelvic surgery divided into two groups, pregnancy rate on two groups of comparison χ2=0.138, P=0.710. According to whether had a history of abortion divided into two groups, pregnancy rate on two groups of comparison χ2=2.480, P=0.115. According to preoperative gynecological sonography showing the pelvic cavity accumulates fluid long drive for "a", wide drive for "b", divided into (a+b≤4cm) and (a+b>4cm) two groups, pregnancy rate on two groups of comparison χ2=2.446, P=0.118. According to the fluid under hysteroscopic tubal intubation results divided into bilateral oviduct tubes and side unobstructed two groups, pregnancy rate on two groups of comparison χ2=0.195, P=0.659.Results showed that could not think pelvic surgery history, history of abortion, pelvic cavity accumulates fluid level, oviduct tubes situation four factors were the influence factors of pregnancy rates of tubal infertility patients who have been treated by hysteroscope and laparoscope (P>0.05).4. Multivariate analysis:four factors coming from the single factor analysis results showing P<0.1were taken into logistic analysis, and the results indicated that the final selection variable only soft degree, tubal pelvic adhesion degree, hydrosalpinx degree three factors, their respective regression coefficient, OR value respectively is:1.13、3.100,1.12、3.077,0.892、2.439.So that the above three factors were the influence factors of pregnancy rates of tubal infertility patients who have been treated by hysteroscope and laparoscope (P<0.05), and history of tubal pregnancy was out,which showed that rule out other interference, could not believe that it was the influence factors of pregnancy rates.ConclusionsOviduct soft degree, pelvic adhesion degree, hydrosalpinx degree could be the influence factors of pregnancy rate of tubal infertility patients who had been treated by hysteroscope and laparoscope. |
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