Relationship Research About Effect Of Treatment Of A Previous Ectopic Pregnancy On In Vitro Fertilization/Intracytoplasmic Sperm Injection Outcomes

Part I EFFECT OF TREATMENT OF A PREVIOUS ECTOPIC PREGNANCY ON IN VITRO FERTILIZATION-INTRACYTOPLASMIC SPERM INJECTION OUTCMOES:A RETROSPECTIVE COHORT STUDYBackground:Ectopic pregnancy(EP)occurs when the fertilized ovum implants in a site other than the endometrial cavity.It is unclear whether there are molecular or histologic changes that can predispose a woman to EP.Although the exact etiology of EP is unknown,current evidence suggests that EP is caused by a combination of impaired embryo tubal transport in the fallopian tube and alterations in the tubal environment.The incidence of this condition in developed countries is 1～2%and is slightly lower in developing countries.The incidence of EP has been on the rise accompanying increased infertility and use of assisted reproductive technologies(ART).The management of EP can be divided into expectant management versus medical or surgical intervention.Surgical management includes salpingectomy,a procedure in which the affected fallopian tube is removed,and salpingostomy,which is defined as surgical removal of the EP from the fallopian tube via an incision in the tube that preserves the affected fallopian tube.Previous studies concluded that EP was itself a risk factor for recurrent EP,however,few studies had investigated both effect and the recurrence incidence of EP after IVF-ICSI.OBJECTIVE:To evaluate the influence of previous ectopic pregnancies and different EP treatment methods on in vitro fertilization-intracytoplasmic sperm injection(IVF-ICSI)outcomes.METHODS:We performed this retrospective cohort study at the Center for Reproductive Medicine,Reproductive Hospital Affiliated to Shandong University,and collected electronic records of women who underwent IVF-ICSI treatments from January 2009 to December 2014.We used the principle of homogeneous mathching to match the experimental group,which 4187 patients got a history or histories of EP,and control group,which 4187 patients got fallopian tube disease without EP.To evaluate the recurrence risk of EP with conservative drug treatment and surgical treatments,the experimental group was further categorized into three subgroups based on the treatment of the previous EP.Patients were divided into conservative treatment group,salpingostomy group and salpingectomy group.OUTCOMES:The main outcomes,such as delivery rate(34.72%VS 33.60%,P=0.266),clinical pregnancy rate(43.59%VS 42.44%,P=0.311),miscarriage rate(16.82%VS 15.92%,P=0.313)have no statistically significant difference.The incidence of EP after IVF-ICSI in the experimental group was higher than in the control group(5.10%VS 3.66%,P=0.025),statistically significant difference.In the subgroup analysis,we settled conservative group versus salpingostomy group as P1,conservative group versus salpingectomy group as P2,salpingostomy group versus salpingectomy group as P3.There was no statistically significant difference in delivery rate(P1=0.553,P2=0.056,P3=0.064),clinical pregnancy rate(P1=0.959,P2=0.147,P3=0.057),miscarriage rate(P 1=0.776,P2=0.256,P3=0.102)and recurrent ectopic pregnancy rate(P1=0.617,P2=:0.584,P3=0.814).The follicle numbers in fallopians of two surgery methods are not statistically significant difference.CONLUSION:Previous EP and different EP treatment methods before IVF-ICSI have no significant adverse effect on the main IVF-ICSI outcomes such as delivery rate and clinical pregnancy rate,however,women who have a history of EP appear to be at risk for recurrent EP after IVF-ICSI treatment compared with women whose infertility was mainly due to tubal factors but who did not have a history of EP.Compared with surgical treatment,conservative drug management does not increase the recurrence risk of EP and could be considered as a first-line treatment for EP whenPART II UTILITY AND PREDICTIVE VALUE OF SERUM BIOMARKERS IN TUBAL ECTOPIC PREGNANCYTubal ectopic pregnancy is a considerable cause of maternal morbidity that can be fatal due to potential tubal rupture and haemorrhage if left undiagnosed.Nowadays,the incidence of tubal ectopic pregnancy is increasing due to rising incidence of assisted reproductive techniques.In general,the majority of patients undergoing menelipsis,abdomen pain and bleeding in early pregnancy,ultrasound scan can ascertain the diagnosis of tubal ectopic pregnancy if possible to locate the implantation.However,if the ultrasound proves inconclusive,a series of serum biomarkers should be utility and prediction in diagnosis of tubal ectopic pregnancy in early pregnancy.Based on different types of serum biomarkers,we divided them into 5 types.First is markers of abnormal embryo/trophoblast growth such as human chorionic gonadotrophin,human placental lactogen and activin A rising irregularly,second is steroids from the corpus luteum such as progesterone and oestradiol secreting abnormal,peptides from the corpus luteum such as inhibin A secreting unusually,third is markers of growing pregnancy in the fallopian tube such as creatine kinase and vascular endothelial growth factor rising,fourth is markers of inflammation and peritoneal irritation such as cancer antigen 125 and IL-2R,IL-6,IL-8,TNF secreting abnormal,and the fifth is uterine markers of normal implantation such as leukaemia inhibitory factor and placental protein-14 declining.A series of serum biomarker would be more accurately and quickly assayed in an emergency department for tubal ectopic pregnancy.The function of one or more it is permitted.serum biomarkers in ectopic pregnancy diagnosis is undetermined.Furthermore,with the advent of better imaging techniques,the importance may become a series of serum biomarker examining with ultrasound-related technology in early ectopic pregnancy diagnosis.