在体外受精前对深部浸润性子宫内膜异位症进行广泛切除可显著提高妊娠率。
Extensive excision of deep infiltrative endometriosis before in vitro fertilization significantly improves pregnancy rates.
作者信息
Bianchi Paulo H M, Pereira Ricardo M A, Zanatta Alysson, Alegretti Jose Roberto, Motta Eduardo L A, Serafini Paulo C
机构信息
Huntington Medicina Reprodutiva, São Paulo, Brazil.
出版信息
J Minim Invasive Gynecol. 2009 Mar-Apr;16(2):174-80. doi: 10.1016/j.jmig.2008.12.009.
STUDY OBJECTIVE
We sought to compare the outcomes of in vitro fertilization (IVF) treatments in women with infertility-associated deep infiltrative endometriosis (DIE) who underwent extensive laparoscopic excision of endometriosis before IVF with those who underwent IVF only.
DESIGN
Prospective cohort study.
SETTING
Infertility clinic and private hospital in São Paulo, Brazil.
PATIENTS
A total of 179 infertile patients younger than 38 years had symptoms and/or signs of endometriosis and sonographic images suggestive of DIE.
INTERVENTIONS
After thorough counseling, 179 women were invited to participate in a prospective cohort study with 2 treatment options: IVF without undergoing laparoscopic surgery (group A, n = 105) and extensive laparoscopic excision of DIE before IVF (group B, n = 64). Ten women were lost to follow-up. The IVF outcomes were compared between the 2 groups.
MEASUREMENTS AND MAIN RESULTS
In group B, patients had 5 +/- 2 (mean +/- SD) DIE lesions excised during laparoscopy. Patient characteristics in groups A and B, respectively, were: age (32 +/- 3 vs 32 +/- 3 years, p = .94), infertility duration (29 +/- 20 vs 27 +/- 17 months, p = .45), day-3 serum follicle-stimulating hormone levels (5.6 +/- 2.5 vs 5.9 +/- 2.5 IU/L, p = .50), and previous IVF attempts (1 +/- 1 vs 2 +/- 1, p = .01). The IVF outcomes differed between groups A and B, respectively, with regard to total dose of recombinant follicle-stimulating hormone required to accomplish ovulation induction (2380 +/- 911 vs 2542 +/- 1012 IU, p = .01), number of oocytes retrieved (10 +/- 5 vs 9 +/- 5, p = .04), and pregnancy rates (24% vs 41%, p = .004), but not number of embryos transferred (3 +/- 1 vs 3 +/- 1, p = 1). The odds ratio of achieving a pregnancy were 2.45 times greater in group B than in group A.
CONCLUSION
Extensive laparoscopic excision of DIE significantly improved IVF pregnancy rates of women with infertility-associated DIE.
研究目的
我们试图比较患有与不孕症相关的深部浸润性子宫内膜异位症（DIE）的女性，在体外受精（IVF）前接受广泛腹腔镜下子宫内膜异位症切除术与仅接受IVF治疗的结果。
设计
前瞻性队列研究。
地点
巴西圣保罗的不孕症诊所和私立医院。
患者
共有179名年龄小于38岁的不孕患者，有子宫内膜异位症的症状和/或体征，且超声图像提示为DIE。
干预措施
在进行充分的咨询后，179名女性被邀请参与一项前瞻性队列研究，有两种治疗方案：未进行腹腔镜手术的IVF（A组，n = 105）和IVF前进行广泛的腹腔镜下DIE切除术（B组，n = 64）。10名女性失访。比较两组的IVF结果。
测量指标和主要结果
在B组中，患者在腹腔镜检查期间切除了5±2（平均值±标准差）个DIE病灶。A组和B组的患者特征分别为：年龄（32±3岁 vs 32±3岁，p = 0.94）、不孕持续时间（29±20个月 vs 27±17个月，p = 0.45）、月经周期第3天血清促卵泡生成素水平（5.6±2.5 IU/L vs 5.9±2.5 IU/L，p = 0.50）以及既往IVF尝试次数（1±1次 vs 2±1次，p = 0.01）。A组和B组的IVF结果在以下方面存在差异：诱导排卵所需的重组促卵泡生成素总剂量（2380±911 IU vs 2542±1012 IU，p = 0.01）、获取的卵母细胞数量（10±5个 vs 9±5个，p = 0.04）和妊娠率（24% vs 41%，p = 0.004），但移植的胚胎数量无差异（3±1个 vs 3±1个，p = 1）。B组实现妊娠的优势比是A组的2.45倍。
结论
广泛的腹腔镜下DIE切除术显著提高了患有与不孕症相关的DIE的女性的IVF妊娠率。
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