Colorado Center for Reproductive Medicine, Lone Tree, Colorado, USA.
Semin Reprod Med. 2013 Mar;31(2):154-63. doi: 10.1055/s-0032-1333481. Epub 2013 Feb 27.
In vitro fertilization (IVF) represents the most efficient means of overcoming endometriosis-related infertility. Compromised pelvic anatomy and a hostile peritoneal environment are bypassed. Despite the results of early trials, more contemporary outcomes data would suggest that when controlled for age, IVF cycle outcome is not compromised by the presence of endometriosis. One exception to this concept is the finding that patients with ovarian endometriomas demonstrate poorer response to gonadotropin therapy, although it is not clear that this affects the likelihood of implantation. Surgical ablation of superficial endometriosis has no clear impact on IVF pregnancy rates, although a small number of recent trials suggest that pre-cycle resection of deeply infiltrative disease may be beneficial. With the exception of traditional gynecologic indications, there is no evidence to suggest that resection of ovarian endometriomas has any positive impact on cycle outcome. There are, in fact, data demonstrating that resection may exert a deleterious effect on ovarian reserve. A subset of patients will benefit from administration of a prolonged course of a gonadotropin-releasing hormone agonist prior to an IVF cycle. However, the characteristics of that subset have not been identified. It would be logical to consider this approach in women with more advanced disease, severe symptoms, and a history of implantation failure. Data on the impact of other pre-cycle medical interventions such as aromatase inhibitors, danazol, or oral contraceptives are more limited. There is also no evidence to suggest that the ovarian stimulation associated with IVF induces progression of endometriosis.
体外受精（IVF）是克服子宫内膜异位症相关不孕的最有效手段。它绕过了受损的盆腔解剖结构和不良的腹膜环境。尽管早期试验的结果表明，当控制年龄因素时，IVF 周期的结果不会因子宫内膜异位症的存在而受到影响，但更现代的结果数据表明并非如此。这种情况的一个例外是发现卵巢子宫内膜异位症患者对促性腺激素治疗的反应较差，尽管尚不清楚这是否会影响着床的可能性。尽管少数最近的试验表明，在周期前切除深部浸润性疾病可能有益，但对浅表子宫内膜异位症的手术消融对 IVF 妊娠率没有明显影响。除了传统的妇科适应证外，没有证据表明切除卵巢子宫内膜异位症对周期结果有任何积极影响。实际上，有数据表明切除可能对卵巢储备产生有害影响。一小部分患者将受益于在 IVF 周期前接受促性腺激素释放激素激动剂的延长疗程。然而，尚未确定该亚组的特征。对于疾病更严重、症状更严重且有植入失败史的女性，考虑这种方法是合理的。关于其他周期前医疗干预（如芳香酶抑制剂、丹那唑或口服避孕药）的影响的数据则更为有限。也没有证据表明与 IVF 相关的卵巢刺激会导致子宫内膜异位症的进展。
