Xueyi Jiang, Shutian Jiang, Hongyuan Gao, Jing Ye, Yanping Kuang
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Cohorts were assigned according to the number of previous spontaneous EP by propensity score matching. After propensity score matching, there were 3252 participants in the no previous EP history cohort (NEP cohort), 3252 in the one EP history cohort (One-EP cohort), and 1571 in the 2 or more EP history cohort (> = 2 EP cohort). To assess the effect of previous salpingectomy on IVF-EP, One-EP cohort and > =2 EP cohort were divided into three subcohorts separately, according to their tubal statuses.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The IVF-EP rate was significantly higher in patients with EP history (NEP cohort: 1.3% vs. One-EP cohort: 2.2% vs. >=2 EP cohort: 2.0%, <i>p</i> = 0.023). In subcohort analysis, patients with different tubal statuses presented no statistical differences in IVF-EP rate (both in One-EP cohort and > =2 EP cohort). Considering the interaction between tubal status and number of previous EP, binary logistic regression was performed and it was demonstrated that bilateral salpingectomy might reduce the risk of IVF-EP in patients with recurrent EP history but increase the risk of non-tubal IVF-EP, while the history of spontaneous EP increased both IVF-EP and non-tubal IVF-EP rate.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Previous EP history was associated with a higher risk of IVF-EP and non-tubal IVF-EP. 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引用次数: 0
摘要
宫外孕（EP）是临床上严重的妇科急症。有EP病史的患者在IVF/ICSI （IVF-EP）中发生EP的风险更高。此外，研究表明，既往EP治疗可能影响IVF-EP的发生率。然而，这个结果并没有考虑由于先前EP的数量而可能产生的混杂因素。因此，我们评估了输卵管切除术对不同既往自发性EP患者的IVF-EP风险和特征的影响。材料和方法：本回顾性队列研究包括2013年1月至2022年6月在我中心接受首次IVF/ICSI治疗的43 647例患者。通过倾向评分匹配，根据先前自发性EP的数量分配队列。经倾向评分匹配后，无EP病史队列（NEP队列）3252人，有EP病史队列（one -EP队列）3252人，有2例及以上EP病史队列（> = 2例EP队列）1571人。为了评估既往输卵管切除术对IVF-EP的影响，将1 -EP队列和> =2 EP队列根据其输卵管状态分别分为三个亚队列。结果：有EP病史的患者的IVF-EP率显著更高（NEP队列：1.3% vs. One-EP队列：2.2% vs. >=2 EP队列：2.0%,p = 0.023）。在亚队列分析中，不同输卵管状态患者的IVF-EP率无统计学差异（1 -EP队列和> =2 EP队列）。考虑到输卵管状态与既往EP次数的相互作用，进行二元logistic回归分析，结果表明双侧输卵管切除术可降低EP复发患者的IVF-EP风险，但增加非输卵管性IVF-EP的风险，而自发性EP病史增加了IVF-EP和非输卵管性IVF-EP的发生率。结论：既往EP病史与体外受精-EP和非输卵管性体外受精-EP的高风险相关。输卵管切除术降低了有EP病史患者发生IVF-EP的总体风险，而双侧输卵管切除术增加了发生非输卵管性IVF-EP的风险。
Impact of salpingectomy on the risk and characteristics of ectopic pregnancy after IVF/ICSI in patients with ectopic pregnancy history: A large retrospective cohort study
Introduction
Ectopic pregnancy (EP) is a serious clinical gynecological emergency. Patients with EP history are at higher risk of EP resulting from IVF/ICSI (IVF-EP). Besides, studies have suggested that previous EP treatments may affect the incidence of IVF-EP. However, this result does not consider possible confounding factors due to the number of previous EP. Therefore, we assessed the impact of salpingectomy on the risk and characteristics of IVF-EP in patients with different previous spontaneous EP.
Material and Methods
This retrospective cohort study included 43 647 patients receiving their first IVF/ICSI treatments at our center from January 2013 to June 2022. Cohorts were assigned according to the number of previous spontaneous EP by propensity score matching. After propensity score matching, there were 3252 participants in the no previous EP history cohort (NEP cohort), 3252 in the one EP history cohort (One-EP cohort), and 1571 in the 2 or more EP history cohort (> = 2 EP cohort). To assess the effect of previous salpingectomy on IVF-EP, One-EP cohort and > =2 EP cohort were divided into three subcohorts separately, according to their tubal statuses.
Results
The IVF-EP rate was significantly higher in patients with EP history (NEP cohort: 1.3% vs. One-EP cohort: 2.2% vs. >=2 EP cohort: 2.0%, p = 0.023). In subcohort analysis, patients with different tubal statuses presented no statistical differences in IVF-EP rate (both in One-EP cohort and > =2 EP cohort). Considering the interaction between tubal status and number of previous EP, binary logistic regression was performed and it was demonstrated that bilateral salpingectomy might reduce the risk of IVF-EP in patients with recurrent EP history but increase the risk of non-tubal IVF-EP, while the history of spontaneous EP increased both IVF-EP and non-tubal IVF-EP rate.
Conclusions
Previous EP history was associated with a higher risk of IVF-EP and non-tubal IVF-EP. Salpingectomy reduced the overall risk of IVF-EP in patients with EP history, while bilateral salpingectomy increased the risk of non-tubal IVF-EP.
期刊介绍：
Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.
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