両側卵管水腫に伴うART反復不成功例の治療指針

Abstract

Objectives: To evaluate the reproductive outcomes of infertile patients who underwent laparoscopic surgery for hydrosalpinx and to propose a guideline for repeated assisted reproductive technology (ART) failures in patients with hydrosalpinx. Design: Retrospective analysis.Setting: The Gynecologic Laparoscopic Surgery Group of Kurashiki Medical Center and IVF Center at the Kurashiki Medical Clinic.Patient(s): The study included 31 infertile patients with bilateral tubal obstruction who were treated from January 2010 to October 2013. Nine of these patients underwent laparoscopic surgery because of repeated pregnancy failures after ART. We suggested the clinical records of patients who immediately conceived after surgery.Intervention(s): Laparoscopic salpingectomy and salpingostomy.Main Outcome Measure(s): Pregnancy after surgery.Result(s): Among the patients with severe hydrosalpinx who underwent salpingectomy, there were 4 patients with a hydrosalpinx diameter > 25 mm and 3 patients with a hydrosalpinx diameter < 25 mm. All the patients undergoing salpingostomy had fallopian tubes that were undetectable on ultrasound scanning (USS). The reason for repeated failure of ART for the patients undergoing salpingectomy was disordered implantation of good-quality embryos, while for the patients undergoing salpingostomy, there was 1 case of disordered implantation of good-quality embryos and 1 case with inadequate embryos. [Case 1] A 35-year-old nulliparous woman had severe hydrosalpinx that was diagnosed as swelling of the oviduct on hysterosalpingography (HSG), vaginal USS, and magnetic resonance imaging (MRI). The patient repeatedly failed to conceive, despite the transfer of high-quality blastcysts. After laparoscopic salpingectomy was performed, successful implantation was achieved with the first blastcyst transfer. [Case 2] A 26-year-old nulliparous woman repeatedly failed to conceive after ART. High-quality blastcysts were not obtained during 3 ART cycles. The patient was diagnosed with mild hydrosalpinx because the fallopian tubes were only visible on HSG but not on USS or MRI. Laparoscopic salpingostomy was performed. The patient conceived spontaneously 2 months after surgery.Conclusion(s): The therapeutic strategies for patients with hydrosalpinx and failure to conceive after repeated ART should be based on both the severity of hydrosalpinx and the type of ART failures.