Rossi A Cristina, Prefumo Federico
Department of Obstetrics and Gynecology, Fabio Perinei Hospital, Bari, Italy.
Department of Obstetrics and Gynecology, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
Arch Gynecol Obstet. 2016 Sep;294(3):647-55. doi: 10.1007/s00404-016-4136-4. Epub 2016 Jun 14.
To review the literature about the effect of endometriosis on in vitro-fertilization and embryo-transfer (IVF-ET).
A search in EMBASE, MEDLINE, ClinicalTrial.gov, reference lists from 2000 to 2013 was conducted. Inclusion criteria were: endometriosis confirmed with histologic examination, women undergoing IVF-ET, endometriosis treated or diagnosed by surgery. Women undergoing IVF-ET after surgical removal of endometriosic implants, or a surgical diagnosis of endometriosis without its removal, were compared to women without endometriosis. Main outcomes were clinical pregnancy and delivery rates.
Thirteen studies were selected, including 980 women with endometriosis and 5934 controls. Clinical pregnancy rate was lower in women with endometriosis than in controls (OR 0.65; 95 % CI 0.44-0.96), but delivery rate was similar (OR 1.17; 95 % CI 0.69-1.98). When surgery was operative, clinical pregnancy rate after IVF-ET was lower in endometriosis than controls (OR 0.54; 95 % CI 0.34-0.85), but delivery rate was similar (OR 1.12; 95 % CI 0.60-2.07). When surgery was diagnostic, clinical pregnancy (OR 1.15; 95 % CI 0.46-2.84) and delivery rates (OR 1.65; 95 % CI 0.36-7.45) did not differ between the groups. Site of endometriosis was not related to IVF-ET outcomes. Clinical pregnancy rates were similar between stage I-II and controls (OR 0.99; 95 % CI 0.63-1.56) but lower in stage III-IV than controls (OR 0.45; 95 % CI 0.29-0.70), whereas delivery rate was not associated with stage.
In the presence of endometriosis, the clinical pregnancy rate after IVF-ET is lower than in controls. The prognosis is better for mild endometriosis compared with more advanced stages. Even after surgical removal of endometriosis, IVF-ET results remain worse than in controls.
回顾关于子宫内膜异位症对体外受精-胚胎移植（IVF-ET）影响的文献。
检索了EMBASE、MEDLINE、ClinicalTrial.gov以及2000年至2013年的参考文献列表。纳入标准为：经组织学检查确诊的子宫内膜异位症、接受IVF-ET的女性、经手术治疗或诊断的子宫内膜异位症。将手术切除子宫内膜异位症植入物后或经手术诊断为子宫内膜异位症但未切除的接受IVF-ET的女性与无子宫内膜异位症的女性进行比较。主要结局为临床妊娠率和分娩率。
选取了13项研究，包括980例子宫内膜异位症女性和5934例对照。子宫内膜异位症女性的临床妊娠率低于对照组（OR 0.65；95% CI 0.44 - 0.96），但分娩率相似（OR 1.17；95% CI 0.69 - 1.98）。当手术为治疗性时，子宫内膜异位症患者IVF-ET后的临床妊娠率低于对照组（OR 0.54；95% CI 0.34 - 0.85），但分娩率相似（OR 1.12；95% CI 0.60 - 2.07）。当手术为诊断性时，两组间临床妊娠率（OR 1.15；95% CI 0.46 - 2.84）和分娩率（OR 1.65；95% CI 0.36 - 7.45）无差异。子宫内膜异位症的部位与IVF-ET结局无关。I-II期患者与对照组的临床妊娠率相似（OR 0.99；95% CI 0.63 - 1.56），但III-IV期患者低于对照组（OR 0.45；95% CI 0.29 - 0.70），而分娩率与分期无关。
存在子宫内膜异位症时，IVF-ET后的临床妊娠率低于对照组。轻度子宫内膜异位症的预后优于更晚期。即使手术切除子宫内膜异位症后，IVF-ET结果仍比对照组差。
