Ballester Marcos, Roman Horace, Mathieu Emmanuelle, Touleimat Salma, Belghiti Jeremy, Daraï Emile
Department of Obstetrics and Gynecology, Tenon University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; GRC-6 UPMC: Centre Expert en Endométriose (C3E), Université Pierre et Marie Curie, Paris, France; Unité INSERM UMR_S 938, Université Pierre et Marie Curie, Paris, France.
Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France.
Eur J Obstet Gynecol Reprod Biol. 2017 Feb;209:95-99. doi: 10.1016/j.ejogrb.2016.02.020. Epub 2016 Feb 22.
OBJECTIVE(S): To assess fertility outcomes after ICSI-IVF in infertile women having undergone prior complete surgical removal of colorectal endometriosis.
Prospective longitudinal cohort study in two referral French centres including 60 infertile women who underwent ICSI-IVF after complete surgical removal of colorectal endometriosis, from January 2005 to May 2014. Women underwent either conservative colorectal surgery (i.e., rectal shaving or full thickness disc excision, n=18) or segmental colorectal resection (n=42). Clinical pregnancies were defined by the presence of a gestational sac on vaginal ultrasound examination from the fifth week. The overall pregnancy rate was calculated. The Kaplan-Meier method was used to estimate the cumulative pregnancy rate (CPR). Comparisons of CPR were made using the log-rank test to detect determinant factors.
The median number of ICSI-IVF cycles per patient was one (range: 1-4). Of the 60 women, 36 became pregnant (i.e., overall pregnancy rate=60%). The CPR was 41.7% after one ICSI-IVF cycle, 65% after two ICSI-IVF cycles and 78.1% after three ICSI-IVF cycles. A decreased CPR was observed for women who required segmental colorectal resection compared to those who underwent rectal shaving or full thickness disc excision (p=0.04). A trend for a decreased CPR was observed for women who received a first ICSI-IVF cycle more than 18 months following surgery (p=0.07). Among the nine women with prior ICSI-IVF failure, five (55.5%) became pregnant after surgery.
CONCLUSION(S): Colorectal surgery for endometriosis completed by ICSI-IVF is a good option for women with proven infertility, even if prior ICSI-IVF had failed.
评估先前已接受结直肠子宫内膜异位症完全手术切除的不孕女性在进行卵胞浆内单精子注射-体外受精（ICSI-IVF）后的生育结局。
在法国两个转诊中心进行的前瞻性纵向队列研究，纳入了2005年1月至2014年5月间60例在结直肠子宫内膜异位症完全手术切除后接受ICSI-IVF的不孕女性。这些女性接受了保守性结直肠手术（即直肠剃除术或全层盘状切除术，n = 18）或节段性结直肠切除术（n = 42）。临床妊娠定义为自第五周起经阴道超声检查发现妊娠囊。计算总体妊娠率。采用Kaplan-Meier方法估计累积妊娠率（CPR）。使用对数秩检验比较CPR以检测决定因素。
每位患者ICSI-IVF周期的中位数为1（范围：1 - 4）。60例女性中，36例怀孕（即总体妊娠率 = 60%）。一个ICSI-IVF周期后的CPR为41.7%，两个ICSI-IVF周期后为65%，三个ICSI-IVF周期后为78.1%。与接受直肠剃除术或全层盘状切除术的女性相比，需要节段性结直肠切除术的女性CPR降低（p = 0.04）。手术18个月后接受首个ICSI-IVF周期的女性CPR有降低趋势（p = 0.07）。在先前ICSI-IVF失败的9例女性中，5例（55.5%）术后怀孕。
对于已证实不孕的女性，即使先前ICSI-IVF失败，通过ICSI-IVF完成的结直肠子宫内膜异位症手术仍是一个不错的选择。
