Leone Roberti Maggiore Umberto, Gupta Janesh Kumar, Ferrero Simone
Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132 Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy.
Birmingham Women's NHS Foundation Trust, Birmingham, United Kingdom.
Eur J Obstet Gynecol Reprod Biol. 2017 Feb;209:81-85. doi: 10.1016/j.ejogrb.2016.02.035. Epub 2016 Feb 28.
Endometrioma is a frequent clinical manifestation of endometriosis. It is controversial how endometriomas may affect women's fertility. This review addresses: the impact of the endometrioma per se and of its surgical treatment on ovarian physiology, on the ovarian reserve, on spontaneous conception and pregnancy outcomes, and on IVF/ICSI outcomes. Based on current evidence, although there are plausible biological detrimental effects on the ovarian cortex surrounding the endometrioma and an impairment of the normal ovarian physiology, the clinical impact of the endometrioma per se is not significantly altered. There is a negligible detrimental effect on ovarian reserve with spontaneous ovulation not being impaired. Conversely, surgical excision of an endometrioma reduces ovarian reserve as measured by AMH levels. Studies investigating the impact of the endometrioma per se and of its surgical treatment in women requiring IVF/ICSI show similar implantation rates, clinical pregnancy rates and live birth rates between women with endometrioma and controls.
卵巢巧克力囊肿是子宫内膜异位症常见的临床表现。卵巢巧克力囊肿如何影响女性生育能力，目前仍存在争议。本综述探讨了：卵巢巧克力囊肿本身及其手术治疗对卵巢生理功能、卵巢储备功能、自然受孕及妊娠结局以及体外受精/卵胞浆内单精子注射结局的影响。基于目前的证据，尽管卵巢巧克力囊肿对其周围的卵巢皮质存在可能的生物学损害作用，并损害正常的卵巢生理功能，但卵巢巧克力囊肿本身的临床影响并未显著改变。对卵巢储备功能的损害可忽略不计，自然排卵未受影响。相反，通过抗缪勒氏管激素水平测定，卵巢巧克力囊肿的手术切除会降低卵巢储备功能。对需要进行体外受精/卵胞浆内单精子注射的女性，关于卵巢巧克力囊肿本身及其手术治疗影响的研究表明，患有卵巢巧克力囊肿的女性与对照组之间的着床率、临床妊娠率和活产率相似。
