Karabacak O, Kambic R, Gursoy R, Ozeren S
University of Kocaeli School of Medicine, Department of Obstetrics and Gynecology, Izmit, Turkey.
Int J Fertil Womens Med. 1999 Jan-Feb;44(1):38-42.
To determine the effectiveness of ovulation induction after laparoscopic treatment of endometriosis in an infertile population.
An observational prospective study in which infertility cases were treated with laparoscopic surgery was followed up (mean 11 months), either by treatment (ovulation induction) or no further treatment (expectant management) and the outcomes recorded. In both groups pregnancies were compared by Cox's regression survival model.
Gazi University Hospital, Department of Obstetric and Gynecology, Ankara, Turkey.
Infertile women with different stages of endometriosis who were treated by laparoscopic surgery, with a mean duration of infertility of 80.7 (+/-50 [SD]) months.
Patients were treated by cauterization of the foci, adhesiolysis, endometrioma stripping, and distal tubal reconstruction according to their lesions. Postoperatively, patients had either ovulation induction (clomiphene, hMG) therapy or no further treatment.
Cumulative pregnancy rate of infertile women after laparoscopic treatment of endometriosis with or without ovulation induction.
A total of 36 out of 128 patients became pregnant after laparoscopy, with a 34% cumulative pregnancy rate. In the ovulation induction group, relative risk (chance) of pregnancy was 1.42 (1.02-2.05, 95 % CI) when the duration of infertility was less than 5 years. In this lower risk group, the overall cumulative pregnancy rate was 46%--56% and 27% for the ovulation induction and expectant management groups, respectively. In the expectant management group, per cycle fecundity was 0.021, whereas it was 0.066 and 0.174 (p = 0.001) in the clomiphene citrate- and hMG-treated patients, respectively. Expectant management significantly increased the likelihood of pregnancy compared to ovulation induction in previous pregnancy, stage 1 or 2 endometriosis, and no male infertility groups (p = 0.04-0.009).
After laparoscopic treatment of endometriosis, ovulation induction has a positive effect only if done with hMG and the duration of infertility was less than 5 years (P<.05).
确定在不孕人群中，腹腔镜治疗子宫内膜异位症后诱导排卵的有效性。
一项观察性前瞻性研究，对接受腹腔镜手术治疗的不孕病例进行随访（平均11个月），分为治疗组（诱导排卵）或未进一步治疗组（期待治疗），并记录结果。两组均通过Cox回归生存模型比较妊娠情况。
土耳其安卡拉加齐大学医院妇产科。
接受腹腔镜手术治疗的不同阶段子宫内膜异位症不孕女性，平均不孕时间为80.7（±50[标准差]）个月。
根据病变情况，对病灶进行烧灼、粘连松解、卵巢巧克力囊肿剥除及输卵管远端重建。术后，患者接受诱导排卵（克罗米芬、人绝经期促性腺激素）治疗或未进一步治疗。
腹腔镜治疗子宫内膜异位症后，不孕女性接受或未接受诱导排卵的累积妊娠率。
128例患者中，共有36例在腹腔镜检查后怀孕，累积妊娠率为34%。在诱导排卵组，不孕时间小于5年时，妊娠相对风险（机会）为1.42（1.02 - 2.05，95%可信区间）。在这个低风险组中，诱导排卵组和期待治疗组的总体累积妊娠率分别为46% - 56%和27%。在期待治疗组，每个周期的受孕几率为0.021，而在克罗米芬治疗组和人绝经期促性腺激素治疗组分别为0.066和0.174（p = 0.001）。与诱导排卵相比，既往有妊娠史、子宫内膜异位症1期或2期以及无男性不育的患者组中，期待治疗显著增加了妊娠可能性（p = 0.04 - 0.009）。
腹腔镜治疗子宫内膜异位症后，仅当使用人绝经期促性腺激素且不孕时间小于5年时，诱导排卵才有积极效果（P <.05）。
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