Pabuccu Recai, Onalan Gogsen, Goktolga Umit, Kucuk Tansu, Orhon Esat, Ceyhan Temel
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Gulhane School of Medicine, 06018 Etlik, Ankara, Turkey.
Fertil Steril. 2004 Sep;82(3):705-11. doi: 10.1016/j.fertnstert.2004.02.117.
To investigate whether aspiration of ovarian endometriomas before controlled ovarian stimulation (COH) improves intracytoplasmic sperm injection (ICSI) outcomes.
Prospective study.
University hospital.
PATIENT(S): A prospective analysis of 171 patients with ovarian endometriosis and tubal factor infertility were divided into four groups: aspiration of endometriomas at the beginning of COH in patients with ovarian endometriomas and no history of previous surgery (n = 41) (group 1); nonaspirated endometriomas (n = 40) (group 2); history of ovarian surgery for endometriomas in patients without ovarian endometriomas at the beginning of COH (n = 44) (group 3); and tubal factor infertility (n = 46) (control group 4).
INTERVENTION(S): Aspiration of endometriomas.
MAIN OUTCOME MEASURE(S): Clinical parameters, characteristics of COH, and ICSI results were analyzed.
RESULT(S): We observed higher levels of E(2) on the day of hCG injection after aspiration of endometriomas compared with nonaspirated endometriomas. When we compared all endometriomas and tubal factor (control) groups, we observed a lower number of total follicles (>17 mm) and metaphase II (MII) oocytes in nonaspirated and resected endometrioma groups and a longer duration of COH in the nonaspirated endometrioma group compared with the tubal factor group. Implantation and clinical pregnancy rates were similar among all groups.
CONCLUSION(S): In the current study, all patients with endometriomas had significantly lower numbers of MII oocytes compared with those in patients with tubal factor infertility. We propose that aspiration of endometriomas before COH neither reduces the amount of gonadotropins nor increases the number of follicles >17 mm, the number of MII oocytes retrieved, the implantation rates, or the clinical pregnancy rates. Resection of small endometriomas (1-6 cm) may not present any additional benefits to the IVF-ICSI cycle outcomes.
探讨在控制性卵巢刺激（COH）前抽吸卵巢子宫内膜异位囊肿是否能改善卵胞浆内单精子注射（ICSI）结局。
前瞻性研究。
大学医院。
对171例卵巢子宫内膜异位症和输卵管因素不孕症患者进行前瞻性分析，分为四组：在COH开始时对有卵巢子宫内膜异位囊肿且既往无手术史的患者抽吸囊肿（n = 41）（第1组）；未抽吸囊肿（n = 40）（第2组）；在COH开始时无卵巢子宫内膜异位囊肿但有卵巢子宫内膜异位囊肿手术史的患者（n = 44）（第3组）；以及输卵管因素不孕症患者（n = 46）（对照组4）。
抽吸子宫内膜异位囊肿。
分析临床参数、COH特征和ICSI结果。
与未抽吸囊肿相比，我们观察到抽吸子宫内膜异位囊肿后hCG注射日的E（2）水平更高。当我们比较所有子宫内膜异位囊肿组和输卵管因素（对照）组时，与输卵管因素组相比，我们观察到未抽吸和已切除子宫内膜异位囊肿组的总卵泡数（>17 mm）和中期II（MII）卵母细胞数较少，且未抽吸子宫内膜异位囊肿组的COH持续时间更长。各组间的种植率和临床妊娠率相似。
在本研究中，所有子宫内膜异位囊肿患者的MII卵母细胞数量均显著低于输卵管因素不孕症患者。我们提出，在COH前抽吸子宫内膜异位囊肿既不会减少促性腺激素用量，也不会增加>17 mm卵泡数、回收的MII卵母细胞数、种植率或临床妊娠率。切除小的子宫内膜异位囊肿（1 - 6 cm）可能对IVF - ICSI周期结局无任何影响。
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