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目的:分析新鲜周期和冻融周期异位妊娠(EP)的发生情况及相关危险因素。方法:回顾分析接受助孕治疗的患者12 209例,共19 144个周期的临床资料,其中新鲜周期移植13 170个、冻融周期5 974个,分析输卵管因素、盆腔手术史、EP手术史、子宫内膜异位症(EMs)及多囊卵巢综合征(PCOS)等因素对异位妊娠发生的影响。结果:新鲜移植周期临床妊娠率显著高于冻融周期(50.12%vs 40.16%),新鲜周期组中IVF-ET周期EP发生率显著高于ICSI-ET组(3.54%vs 1.76%),差异均有统计学意义(P<0.01)。冻融周期异位妊娠率高于新鲜周期组(3.37%vs 3.19%),冻融周期组中激素替代周期EP率高于自然周期(3.48%vs 3.25%),但差异均无统计学意义(P>0.05)。新鲜周期组内,输卵管因素、盆腔手术史、EP手术史均可使EP率较之未合并该危险因素者显著增加(依次为3.51%vs 2.61%;4.57%vs 2.86%;4.99%vs 3.00%),差异有统计学意义(P<0.05)。冻融周期组内,输卵管因素、盆腔手术史、EP手术史亦均可使EP率较之未合并该危险因素者显著增加(依次为4.25%vs 1.69%;7.64%vs 2.67%;11.03%vs 2.88%),差异有统计学意义(P<0.05)。新鲜周期和冻融周期组内比较,有EMs者较之无EMs,有PCOS者较之无PCOS者,EP发生率的差异均无统计学意义(P>0.05)。另将19 144个周期分别依据有无EMs或PCOS分组进行比较,有EMs者EP率高于无EMs者(1.92%vs 1.51%;P>0.05),有PCOS者异位妊娠率高于无PCOS者(3.54%vs1.40%;P<0.01)。结论:冻融周期胚胎移植后EP率略高于新鲜周期;输卵管因素、盆腔手术史、EP手术史是助孕治疗患者EP发生的主要危险因素,合并EMs或PCOS也是EP发生的重要因素。
OBJECTIVE: To analyze the occurrence and related risk factors of fresh and frozen-thawed cycles of ectopic pregnancy (EP). Methods: The clinical data of 12 209 patients with 19 144 cycles were retrospectively analyzed, including 13 170 fresh cycles and 5 974 cycles of frozen-thaw cycles. The effects of tubal factors, pelvic surgery, history of EP, Endometriosis (EMs) and polycystic ovary syndrome (PCOS) and other factors on the incidence of ectopic pregnancy. Results: The clinical pregnancy rate in fresh transplantation period was significantly higher than that in freeze-thaw cycles (50.12% vs 40.16%). The incidence of IVF-ET in fresh cycles was significantly higher than that in ICSI-ET (3.54% vs 1.76% There was statistical significance (P <0.01). The rate of ectopic pregnancy in the freeze-thaw cycles was higher than that in the fresh cycles (3.37% vs 3.19%), and the rate of the hormone replacement cycles in the freeze-thaw cycles was higher than that in the natural cycles (3.48% vs 3.25%), but the differences were not statistically significant P> 0.05). In the fresh cycle group, tubal factors, history of pelvic surgery and history of EP were significantly higher than those without risk factors (3.51% vs 2.61%, 4.57% vs 2.86%, 4.99% vs 3.00% ), The difference was statistically significant (P <0.05). In the group of freezing and thawing, tubal factors, history of pelvic surgery and history of EP also significantly increased the EP rate compared with the non-combined risk factors (4.25% vs 1.69%, 7.64% vs 2.67%, 11.03% vs 2.88% ), The difference was statistically significant (P <0.05). There was no significant difference in the incidence of EP between fresh and frozen-thawed groups with or without EMs compared with those with or without PCOS (P> 0.05). The other 19 144 cycles were based on the presence or absence of EMs or PCOS group compared with EMs EP rate was higher than those without EMs (1.92% vs 1.51%; P> 0.05), with PCOS ectopic pregnancy rate was higher than without PCOS (3.54% vs1.40%; P <0.01). Conclusion: The EP rate of frozen-thawed embryo transfer is slightly higher than that of fresh one. The fallopian tube factors, pelvic operation history and EP operation history are the main risk factors of EP in pregnancy-assisted therapy. Merging EMs or PCOS is also an important factor of EP.