Motte I, Roman H, Clavier B, Jumeau F, Chanavaz-Lacheray I, Letailleur M, Darwish B, Rives N
Department of gynecology and obstetrics, Rouen university hospital, 76031 Rouen, France; Expert Center in the Diagnostic and Multidisciplinar Management of Endometriosis "Rouendometriose", 76031 Rouen, France.
Department of gynecology and obstetrics, Rouen university hospital, 76031 Rouen, France; Expert Center in the Diagnostic and Multidisciplinar Management of Endometriosis "Rouendometriose", 76031 Rouen, France; Research Group 4308 "Spermatogenesis and Gamete Quality", IHU Rouen Normandy, IFRMP23, reproductive biology laboratory, Rouen university hospital, 76031 Rouen, France.
Gynecol Obstet Fertil. 2016 Oct;44(10):541-547. doi: 10.1016/j.gyobfe.2016.08.008. Epub 2016 Sep 21.
Ovarian endometrioma ablation using plasma energy appears to be a valuable alternative to cystectomy, because it could spare underlying ovarian parenchyma resulting in high spontaneous and overall pregnancy rates. After initial postoperative decrease, anti-mullerian hormone (AMH) level progressively increases several months after ablation. The aim of our study was to assess the outcomes of in vitro fertilization (IVF) in women managed for ovarian endometriomas by ablation using plasma energy, when compared to those in women free of endometriosis.
Retrospective preliminary case-control study, enrolling women undergoing IVF or IntraCytoplasmic Sperm Injection (ICSI), from July 2009 to December 2014. Cases were infertile women with previous ovarian endometrioma ablation using plasma energy and were matched by age, AMH level and assisted reproductive technique with controls presumed free of endometriosis. IVF/ICSI response (type of protocol, dose of gonadotrophin, number of oocytes, fertilization rate) and outcomes were compared between the two groups.
In all, 37 cases were compared to 74 controls. Age (30.9±4.4 years vs. 31.7±4.2 years), AMH level (2.8±2ng/mL vs. 2.8±1.7ng/mL) and ART procedures (ICSI in 24.3% vs. 27%) were comparable between the two groups. Of the 37 cases, previous surgical procedures on right and left ovaries were performed in 27% and 21.6% of patients respectively, 81% of patients were nullipara. AFSr score was 73±41, while deep endometriosis infiltrated the rectum and the sigmoid colon in respectively 40.5% and 27% of patients. Despite a lower number of oocytes retrieved, cases presented better implantation rate, pregnancy and delivery rates per cycle, oocyte retrieval, transfer, and embryo, as well as superior cumulative birth rate per transfer.
Ovarian endometrioma ablation using plasma energy is followed by good IVF/ICSI outcomes, suggesting that surgical procedure spares underlying ovarian parenchyma. These results consolidate those of previous studies reporting high spontaneous conception rate. Hence, ovarian endometrioma ablation using plasma energy appears to be a valuable alternative to cystectomy in patients presenting with endometriosis and pregnancy intention.
使用等离子能量消融卵巢子宫内膜异位囊肿似乎是囊肿切除术的一种有价值的替代方法，因为它可以保留卵巢实质，从而获得较高的自然妊娠率和总体妊娠率。消融术后最初的术后下降后，抗苗勒管激素（AMH）水平在消融后数月逐渐升高。我们研究的目的是评估与未患子宫内膜异位症的女性相比，接受等离子能量消融治疗卵巢子宫内膜异位症的女性体外受精（IVF）的结果。
回顾性初步病例对照研究，纳入2009年7月至2014年12月接受IVF或卵胞浆内单精子注射（ICSI）的女性。病例为先前使用等离子能量消融卵巢子宫内膜异位囊肿的不孕女性，并按年龄、AMH水平和辅助生殖技术与假定未患子宫内膜异位症的对照组进行匹配。比较两组的IVF/ICSI反应（方案类型、促性腺激素剂量、卵母细胞数量、受精率）和结果。
总共37例病例与74例对照进行比较。两组的年龄（30.9±4.4岁对31.7±4.2岁）、AMH水平（2.8±2ng/mL对2.8±1.7ng/mL）和ART程序（ICSI分别为24.3%对27%）具有可比性。在37例病例中，分别有27%和21.6%的患者先前对右侧和左侧卵巢进行过手术，81%的患者为未产妇。AFSr评分为73±41，而深部子宫内膜异位症分别累及40.5%和27%的患者的直肠和乙状结肠。尽管获取的卵母细胞数量较少，但病例组的每个周期的着床率、妊娠率和分娩率、卵母细胞获取率、移植率和胚胎情况更好，以及每次移植的累积出生率更高。
使用等离子能量消融卵巢子宫内膜异位囊肿后，IVF/ICSI结果良好，表明手术保留了卵巢实质。这些结果巩固了先前报道高自然受孕率的研究结果。因此，对于有子宫内膜异位症且有妊娠意愿的患者，使用等离子能量消融卵巢子宫内膜异位囊肿似乎是囊肿切除术的一种有价值的替代方法。
