An Analysis Of Clinical Outcomes Of Hysteroscopy And Laparoscopy Combined Surgery For457Cases Of Female Infertility

Objective: To analyze the cause of female infertility and clinical outcomes of thetreatment of combined hysteroscopy and laparoscopy surgery, and to explore the relevantfactors that influence postoperative natural pregnancy.Method: Collect the data of patients underwent hysteroscopy and laparoscopycombined surgery in our hospital from May2010to April2012,and follow up theirpregnancy situation by looking up their referral records or calling, and last calculate thepostoperative pregnancy rate of tubal infertility and explore relevant elements.Results:（1）The study collected a total of457cases of patients(338cases werefollowed up,119cases were lost),including221cases of bilateral tubalblockage(48.36%),98cases of unilateral tubal obstruction(20.13%),111cases ofendometriosis(including81cases of ovarian endometrioid cyst and30cases of pelvicendometriosis),30cases of polycystic ovarian syndrome,10cases of benign ovariantumor,31cases of uterine fibroid,16cases of uterine septum,17cases of intrauterineadhesion,31cases of endometrial polyps,3cases of double uterine malformation,16casesof Fitz–Hugh–Curtis syndrome and16cases of unexplained.The rate of surgicalcomplication was0.44%,the average cost of hospitalization of patients was11300yuan.(2)The spontaneous pregnancy rate after surgery was41.10%,67.16%of which occurredwithin6months after surgery;the rate of ectopic pregnancy was3.07%.There were103patients undergoing in vitro fertilization-embryo transfer (IVF-ET), pregnancy rate was45.63%, and ectopic rate was3.88%.In addition, the IVF-ET pregnancy rate ofsalpingectomy group(n=23) was65.21%,while the IVF-ET pregnancy rate of tubalreserved group(n=80) was40.00%, p＜0.05,the difference was statisticallysignificant.Therefore overall pregnancy rate was53.55%(181/338).(3)The study followed up177cases of tubal infertility, the spontaneous pregnancy rate after surgery was40.11%,and67.16%of which occurred within6months after surgery; the rate of ectopicpregnancy was3.39%. The spontaneous pregnancy rate of tubal infertility after surgerywas negatively correlated with infertility time(β=-0.178，P<0.05）,regardless of age orinfertility type.(4)The spontaneous pregnancy rate of patients with endometriosis(III/IV)after surgery was42.65%(29/68), and the pregnancy rate after surgery and IVF-ET was51.47%(35/68).(5)The pregnancy rate of patients with PCOS after laparoscopic ovariandiathermy was53.85%(14/26).(6)The pregnancy rate of patients with uterine septum aftersurgery was76.92%(10/13).Conclusions:(1)Fallopian tube obstruction was the leading cause of femaleinfertility;(2) The treatment of combined hysteroscopy and laparoscopy surgery is valuableboth in diagnosis and therapy for female infertility, and it should be widely applied for itslow incidence of complications and low cost; The spontaneous pregnancy rate is higherwithin six months after surgery, and IVF-ET should be advised if not achievingspontaneous pregnancy one year after surgery to improve the overall pregnancy rate;(3)The spontaneous pregnancy rate of tubal infertility after surgery was negatively correlatedwith infertility time(β=-0.178，P<0.05）,regardless of age or infertility type.