| Objective:The aim of this study was to retrospectively investigate the risk factors of EP after the in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET),in order to reduce the incidence of the EP.Method:Collect the Reproductive Medicine Special Hospital,the first hospital of Lanzhou University in January 2015 to March 2017 after IVF/ICSI-ET the clinical datas of 170 EP patients,random selected 170 intrauterine pregnancy(IUP)cases from 4757 cases of IUP in the same period as IUP group,collection and analysis the clinical datas of two groups,SPSS22.0statistical software was used to analysis the clinical data.Result:1.The rate of EP:The incidence rate of EP is 3.45%(170/4927).2.Special type EP including:interstitial pregnancy(IP),the incidence rate was0.30%(15/4927).Ovarian pregnancy(OP),abdominal pregnancy,cesarean scar pregnancy(CSP)only two cases and the rate was 0.041%(2/4927).Cervical pregnancy,broad ligament pregnancy,all were 0.02%(1/4927).Heterotopic pregnancy(HP)was 0.45%(22/4927).The cases of recurrent EP were 38 cases and the rate was 0.77%(38/4927).The cases of pregnancy of unknown location was18 cases and the rate was 0.37%(18/4927).3.The single risk factor analysis of EP(1)Tubal factor infertility(TIF),the ratio of EP group was higher,difference has statistical significance(P<0.05).while in other case of infertility difference between two groups has no statistical significance(P>0.05).(2)Pelvic surgery,the history of EP,lower reproductive tract infection compared with IUP group,the ratio of EP group was higher,difference has statistical significance(P<0.05).In insulin resistance(IR),hypothyroidism,overweight(BMI>24 kg/m~2),delivery mode and contraception in two group there was no statistically significant difference(P>0.05).(3)The ratio of frozen thawed embryo transfer(FET)is lower compared with IUP group,difference has statistical significance(P<0.05).The mini-stimulation protocol COH in EP grouptheratioishigher,comparedwithIUP groupdifferencehasstatistical significance(P<0.05).In FET,nature cycle in EP group the ratio is higher and artificial cycle with GnRH-a is lower,compared with IUP group difference has statistical significance(P<0.05).(4)The average number of ET in EP group is more than IUP group,but high quality ET is less than IUP group,difference has statistical significance(P<0.05).The ratio of HCG trigger in EP group is higher and double drugs trigger in IUP group is higher,difference in two groups has statistical significance.The ratio of blastocyst transfer in IUP group is higher compared with EP group,difference has statistical significance(P<0.05).Trigger day of serum progesterone in EP group is higher,compared with IUP group difference has statistical significance(P<0.05).(5)The serum human chorionic gonadotropin(HCG),estradiol(E2),progesterone(P)levels after transfer 14 days in IUP group is higher than IUP group,difference has statistical significance(P<0.05).In this study,121 cases diagnosed by transvaginal sonography(TVS);120cases were cured by laparoscopic surgery,and 43 cases were treated by medicine conservative.4.Binary logistic regression analysis results show that:ET cycle pattern,the drug of trigger ovulation,different endometrial preparation programs in FET were the risk factors of EP(P<0.05,OR>1):fresh cycle,HCG trigger ovulation and nature cycle in can increased the incidence of EP compared with FET,double drugs trigger ovulation,artificial cycle with GnRH-a in FET.Conclusion:1.The kind of special type EP was increased after IVF/ICSI-ET.TFI,pelvic surgery,the history of EP,lower RTI are the risk factors of EP.2.Multiple ET,D3-ET,higher levels of serum P in trigger day,thin EDM,mini-stimulation protocol in fresh cycle are the risk factors of EP.Decline ET and high-quality ET,blastocyst transfer can reduce the incidence of EP.3.Fresh cycle,HCG trigger ovulation and nature cycle in FET can result in an increase incidence of EP.4.TVS has the highest diagnosis rate of EP.The serum HCG level has predictive value in diagnosis EP. |
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