The Effect Of Different Surgical Timing Of Hydrosalpinx On IVF-ET

Part one The effect of hydrosalpinx on IVF-ET pregnancy outcomeObjective: To compare the general data and pregnancy outcomes of patients with oviduct resection and unresectable fallopian tube before controlled ovarian hyperstimulation,and to explore the effect of hydrosalpinx on pregnancy outcomes after embryo transfer.Methods: A retrospective analysis of 96 patients who underwent surgical resection of the oviduct before controlled ovarian hyperstimulation and the first transplant in the Department of Reproductive Medicine of the Second Hospital of Hebei Medical University from January 2012 to December 2017,and case data of 161 patients who had not undergone surgical treatment of hydrosalpinx and were the first embryo transfer were selected as the control group in the same period of time.Inclusion criteria: 1 age ? 35 years;2 menstrual regularity 2-8 days / 22-35 days;3 preoperative evaluation of ovarian function,endometrial normal;4 ovulation induction program is luteal phase long program;5 patients through the uterus Fallopian tube angiography or ultrasound prompts hydrosalpinx.The 6-line frozen embryo transfer patient used an artificial intimal protocol.Exclusion criteria: 1 endometriosis and adenomyosis;2 polycystic ovary syndrome;3 ovarian surgery history;4 uterine malformations,scar uterus,endometrial lesions,intrauterine adhesions;5 tuberculosis,endocrine diseases And the male factor is infertile.Grouping:According to whether the patient removes the hydrosalt tube.Group A: ovarian stimulation after surgical removal of hydrosalpinx.Group A1: Fresh cycle transplantation(n=74);Group A2: frozen embryo transplantation(patients who failed to undergo fresh cycle transplantation due to elevated progesterone levels,prevention of ovarian hyperstimulation syndrome or personal reasons)(n=22).Group C:patients who have not undergone surgical treatment of hydrosalpinx.Group C1: Fresh cycle transplantation(n=119);Group C2: frozen embryo transplantation(patients who failed to undergo fresh cycle transplantation due to elevated progesterone levels,prevention of ovarian hyperstimulation syndrome or personal reasons)(n=42).The general basic data and pregnancy outcomes of patients with A1 and C1 groups,A2 and C2 groups were compared.Result:1.There were no significant differences in age,infertility years,basal FSH level,basal LH level,basal E2 level,primary infertility ratio,and AFC between the two groups of fresh group transplantation in group A1 and group C1(P>0.05).There was no significant difference in the ectopic pregnancy rate,abortion rate,and live birth rate between the two groups(P>0.05).The clinical pregnancy rate of the A1 group was significantly higher than that of the C1 group,and the difference was statistically significant(66.22% vs.47.90%,P=0.013).2.The freeze-thawed embryo transfer between group A2 and group C2 yielded the same results as the fresh cycle.There were no significant differences in age,infertility years,basal FSH level,basal LH level,basal E2 level,primary infertility ratio,and AFC between the group A2 and group C2(P>0.05).There was no significant difference in ectopic pregnancy rate,live birth rate and abortion rate between the two groups(P>0.05).The clinical pregnancy rate of A2 group was significantly higher than that of C2 group.The difference was statistically significant(68.18% vs 40.48%,P=0.035).Conclusions: Hydrosalpinx reduces the clinical pregnancy rate after embryo transfer,and surgical removal of the hydrosalpinx can provide better clinical benefit for patients with hydronephrosis.Part two The effect of different surgical timing of hydrosalpinx onovulation induction and pregnancy outcome in patientsObjective: To analyze the effects of different surgical timings of hydrosalpinx on ovarian response and IVF-ET pregnancy outcomes.Methods: From January 2012 to December 2017,96 patients who met the criteria of the Department of Reproductive Medicine of the Second Hospital of Hebei Medical University met the standard of resecting the fallopian tube and then ovulation.The first transplant patient and the 46 patients who met the standard in the same period were ovulation-free whole embryo freezing.The medical records of the first frozen embryo transfer were performed after resection of the fallopian tube.Inclusion criteria and exclusion criteria are the same as the first part.Grouping: According to the patient's time to surgically remove the fallopian tube and promote ovulationGroup A: ovarian stimulation after surgical removal of hydrosalpinx.Group A1: Fresh cycle transplantation(n=74);Group A2: frozen embryo transplantation(patients who failed to undergo fresh cycle transplantation due to elevated progesterone levels,prevention of ovarian hyperstimulation syndrome or personal reasons)(n=22).Group B :After ovulation is taken,the whole embryo is frozen and then the fallopian tube is resected,and the artificial endometrial cycle is transplanted into the frozen-thawed embryo(n=46).The general data,ovulation induction and pregnancy outcomes of the two groups were compared and analyzed.Result: There were no significant differences in age,infertility,infertility type,body mass index(BMI),basal FSH level,basal LH level,basal E2 level,and basal antral follicle number between the two groups.There was no significant difference in total Gn dose,total Gn days,HCG endometrial thickness,type A endometrial ratio,fertilization rate and cleavage rate between the two groups(P>0.05).The total number of eggs obtained and the number of transplantable embryos in group B were significantly higher than those in group A,and the difference was statistically significant(11.54±2.714 vs 10.46±2.087,P=0.01);(6.37±1.611 vs 5.40±1.425,P<0.01).There was no significant difference in clinical pregnancy rate,ectopic pregnancy rate,abortion rate,and live birth rate between the A1 group and the B group(P>0.05).There were no significant differences in clinical pregnancy rate,ectopic pregnancy rate,abortion rate,and live birth rate between the A2 group and the B group(P>0.05).Conclusions:1.The number of eggs that can be ovulated and the number of available embryos may be more.The cumulative pregnancy rate may be higher than that of patients who have ovulation after surgery.It is recommended that patients with poor ovarian reserve should first ovulate.2.The timing of surgery for hydrosalpinx may have no significant effect on the pregnancy outcome of IVF-ET.