Buck Louis Germaine M, Backonja Uba, Schliep Karen C, Sun Liping, Peterson C Matthew, Chen Zhen
1 Division of Intramural Population Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development , Rockville, Maryland.
2 Division of Biomedical and Health Informatics, Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine , Seattle, Washington.
J Womens Health (Larchmt). 2016 Oct;25(10):1021-1029. doi: 10.1089/jwh.2015.5712. Epub 2016 Jul 5.
Endometriosis is a gynecologic disease reported to be associated with infertility and, possibly, adverse pregnancy outcomes. While considerable research focuses on pregnancy outcomes following diagnosis and/or treatment, few data actually describe women's reproductive history before diagnosis for a more complete understanding of endometriosis and reproduction.
The study sample comprised 473 women (aged 18-44 years) undergoing laparoscopies or laparotomies, irrespective of surgical indication at 14 clinical sites, during the period 2007-2009. Upon enrollment and before surgery, women were queried about pregnancy intentions and the time required to become pregnant for planned pregnancies. Endometriosis was defined as surgically visualized disease. Using discrete time survival analysis, we estimated fecundability odds ratios (FORs) and 95% confidence intervals (CIs) to assess time to pregnancy (TTP) after adjusting for potential confounders (age, body composition, cigarette smoking, site). Generalized estimating equations accounted for multiple pregnancy attempts per woman. FORs <1.0 denote a longer TTP or diminished fecundity.
Approximately 66% and 69% of women with and without endometriosis, respectively, reported having a planned pregnancy before surgery, respectively. After adjustment, an endometriosis diagnosis was associated with ≈29% reduction in fecundity or a longer TTP across all pregnancy-trying attempts (adjusted FOR = 0.71; 95% CI 0.46-1.10). While FORs were consistently <1.0, irrespective of endometriosis staging, CIs included 1.
Women with endometriosis had a longer TTP than unaffected women, irrespective of disease severity, although the findings did not achieve significance. Prior reproductive history may be informative for predicting fecundity and pregnancy outcomes following diagnosis/treatment.
子宫内膜异位症是一种妇科疾病，据报道与不孕以及可能的不良妊娠结局有关。虽然大量研究聚焦于诊断和/或治疗后的妊娠结局，但实际上很少有数据描述女性在诊断前的生殖史，以便更全面地了解子宫内膜异位症与生殖的关系。
研究样本包括2007年至2009年期间在14个临床地点接受腹腔镜检查或剖腹手术的473名女性（年龄18 - 44岁），无论手术指征如何。在入组时及手术前，询问女性的妊娠意愿以及计划妊娠时受孕所需的时间。子宫内膜异位症定义为手术可见的疾病。使用离散时间生存分析，我们估计了受孕几率比（FORs）和95%置信区间（CIs），以评估在调整潜在混杂因素（年龄、身体组成、吸烟、手术地点）后至妊娠的时间（TTP）。广义估计方程考虑了每位女性的多次妊娠尝试。FORs <1.0表示TTP更长或生育力降低。
分别约有66%和69%患子宫内膜异位症和未患子宫内膜异位症的女性报告在手术前有计划妊娠。调整后，子宫内膜异位症诊断与所有妊娠尝试中的生育力降低约29%或TTP延长有关（调整后的FOR = 0.71；95% CI 0.46 - 1.10）。虽然无论子宫内膜异位症分期如何，FORs始终<1.0，但置信区间包含1。
患有子宫内膜异位症的女性TTP比未患病女性更长，无论疾病严重程度如何，尽管研究结果未达到显著水平。既往生殖史可能有助于预测诊断/治疗后的生育力和妊娠结局。
