IVF Unit, Reproductive Medicine Department, Saint Mary's Hospital, Manchester, UK.
Eur J Obstet Gynecol Reprod Biol. 2011 Jun;156(2):177-80. doi: 10.1016/j.ejogrb.2011.01.020. Epub 2011 Feb 25.
To test the hypothesise that the treatment protocol used for preparation of the endometrium for frozen embryo transfer (ET) has a beneficial effect on the disorganised endometrium in women with endometriosis and leads to a higher pregnancy rate.
We performed a retrospective, database-searched cohort study. Relevant information was collected from the electronic records of women who underwent IVF/ICSI between 1/1/2000 and 31/12/2008 in our unit. Endometriosis patients formed the study group. The rest of the women formed the control group. The two groups were subdivided, depending on whether they had fresh or frozen ET. The main outcome was live birth rate (LBR). Secondary outcomes were clinical pregnancy rate (CPR) and miscarriage rate (MR). Comparisons were performed by Chi-square and Mann-Whitney tests (SPSS 16.0).
A total of 3763 fresh and 3523 frozen ET IVF cycles were included in our study, of which 415 (5.7%) were due to endometriosis related subfertility. In the non-endometriosis group, fresh ET had significantly higher LBR, CBR and MR than frozen ET. In women with endometriosis, down-regulated frozen ET cycles had a markedly high LBR and CPR (16.9%, 18.2%), comparable to the LBR and CPR of fresh ET cycles in the same group (19.5%, 20.2%). No significant differences were found in the LBR and CPR in fresh ET cycles between the study and the control group. In frozen ET, however, the CPR was significantly higher in the endometriosis group (18.2% versus 12.7%, P=0.048).
Unlike the general IVF population, in women with endometriosis undergoing IVF, the preparation of the endometrium for frozen ET with GnRH agonists compared to fresh cycles is associated with higher LBR (16.9% versus 11.9%) and a significantly higher CPR (18.2% versus 12.7%, P=0.048). These results suggest that, in cases of endometriosis, the combined effect of GnRHa on the endometrium and the low level of ovarian steroids may simultaneously offer a better endometrial environment for implantation which may lead to better outcomes.
验证这样一种假设，即用于冷冻胚胎移植（ET）的子宫内膜准备的治疗方案对子宫内膜异位症患者的紊乱子宫内膜有有益影响，并导致更高的妊娠率。
我们进行了一项回顾性的数据库搜索队列研究。从我们单位 2000 年 1 月 1 日至 2008 年 12 月 31 日期间接受 IVF/ICSI 的女性的电子记录中收集了相关信息。子宫内膜异位症患者为研究组。其余女性为对照组。两组根据是否有新鲜或冷冻 ET 进一步细分。主要结局是活产率（LBR）。次要结局是临床妊娠率（CPR）和流产率（MR）。采用卡方检验和曼-惠特尼检验（SPSS 16.0）进行比较。
本研究共纳入 3763 例新鲜和 3523 例冷冻 ET IVF 周期，其中 415 例（5.7%）因子宫内膜异位症相关不孕。在非子宫内膜异位症组中，新鲜 ET 的 LBR、CBR 和 MR 明显高于冷冻 ET。在子宫内膜异位症患者中，下调的冷冻 ET 周期具有明显较高的 LBR 和 CPR（16.9%，18.2%），与同一组新鲜 ET 周期的 LBR 和 CPR 相当（19.5%，20.2%）。在新鲜 ET 周期中，研究组和对照组之间的 LBR 和 CPR 无显著差异。然而，在冷冻 ET 中，子宫内膜异位症组的 CPR 明显更高（18.2%比 12.7%，P=0.048）。
与一般 IVF 人群不同，在接受 IVF 的子宫内膜异位症患者中，与新鲜周期相比，使用 GnRH 激动剂准备冷冻 ET 的子宫内膜与更高的 LBR（16.9%比 11.9%）和更高的 CPR（18.2%比 12.7%，P=0.048）相关。这些结果表明，在子宫内膜异位症的情况下，GnRHa 对子宫内膜的综合作用和低水平的卵巢类固醇可能同时为着床提供更好的子宫内膜环境，从而带来更好的结果。
