González-Comadran Mireia, Schwarze Juan Enrique, Zegers-Hochschild Fernando, Souza Maria do Carmo B, Carreras Ramon, Checa Miguel Ángel
Obstetrics and Gynecology, Hospital del Mar, Parc de Salut Mar de Barcelona, Barcelona, Spain.
GRI-BCN, Barcelona Infertility Research Group, Barcelona, Spain.
Reprod Biol Endocrinol. 2017 Jan 24;15(1):8. doi: 10.1186/s12958-016-0217-2.
Endometriosis has been described to impair fertility through various mechanisms. However, studies evaluating the reproductive outcomes of women undergoing assisted reproductive technologies show controversial results. The aim of this study is to assess whether the reproductive outcome is impaired among women with endometriosis-associated infertility undergoing IVF.
A retrospective cohort study was performed, including women undergoing IVF reported by the Red Latinoamericana de Reproduccion Asistida (Redlara) registry, between January 2010 and December 2012. The study group included women with endometriosis-associated infertility, and the control group women with tubal factor, endocrine disorders or unexplained infertility. Women above 40 years, severe male factor and premature ovarian failure were excluded. The reproductive outcomes of between both groups were compared. The primary outcome was live birth. Secondary outcomes included clinical pregnancy, miscarriage, number of oocytes retrieved and number of fertilized oocytes. Outcomes were assessed after the first fresh IVF cycle, and were adjusted for age and number of embryos transferred.
A total of 22.416 women were included (3.583 with endometriosis and 18.833 in the control group). Mean age of patients in the endometriosis group and control group was 34.86 (3.47) and 34.61 (3.91) respectively, p = 0.000. The mean number of oocytes retrieved were 8.89 (6.23) and 9.86 (7.02) respectively, p = 0.000. No significant differences were observed between groups in terms of live birth (odds ratio (OR) 1.032, p = 0.556), clinical pregnancy (OR 1.044, p = 0.428) and miscarriage rates (OR 1.049, p = 0.623). Women with endometriosis had significantly lower number of oocytes retrieved (incidence risk ratio (IRR) 0.917, 95% CI 0.895-0.940), however, the number of fertilized oocytes did not differ among the two groups when adjusting for the number of oocytes retrieved (IRR 1.003, p = 0.794). An age-stratified analysis was performed, and no differences were observed in the reproductive outcomes between groups for women aged under 35 and 35 to 40.
Reproductive outcomes among women undergoing IVF and diagnosed with endometriosis-associated infertility do not differ significantly from women without the disease. Although women with endometriosis generate fewer oocytes, fertilization rate is not impaired and the likelihood of achieving a live birth is also not affected.
子宫内膜异位症已被描述通过多种机制损害生育能力。然而，评估接受辅助生殖技术的女性生殖结局的研究结果存在争议。本研究的目的是评估接受体外受精（IVF）的子宫内膜异位症相关性不孕女性的生殖结局是否受到损害。
进行了一项回顾性队列研究，纳入2010年1月至2012年12月间拉丁美洲辅助生殖登记处（Redlara）报告的接受IVF的女性。研究组包括子宫内膜异位症相关性不孕女性，对照组包括输卵管因素、内分泌紊乱或不明原因不孕的女性。排除40岁以上女性、严重男性因素和卵巢早衰患者。比较两组的生殖结局。主要结局是活产。次要结局包括临床妊娠、流产、取卵数和受精卵数。在第一个新鲜IVF周期后评估结局，并根据年龄和移植胚胎数进行调整。
共纳入22416名女性（3583名患有子宫内膜异位症，18833名在对照组）。子宫内膜异位症组和对照组患者的平均年龄分别为34.86（3.47）岁和34.61（3.91）岁，p = 0.000。平均取卵数分别为8.89（6.23）个和9.86（7.02）个，p = 0.000。两组在活产（优势比（OR）1.032，p = 0.556）、临床妊娠（OR 1.044，p = 0.428）和流产率（OR 1.049，p = 0.623）方面未观察到显著差异。患有子宫内膜异位症的女性取卵数显著较少（发病风险比（IRR）0.917，95%可信区间0.895 - 0.940），然而，在根据取卵数进行调整后，两组的受精卵数没有差异（IRR 1.003，p = 0.794）。进行了年龄分层分析，35岁以下和35至40岁女性组之间的生殖结局未观察到差异。
接受IVF且被诊断为子宫内膜异位症相关性不孕的女性的生殖结局与未患该病的女性没有显著差异。虽然患有子宫内膜异位症的女性产生的卵子较少，但受精率未受损害，活产的可能性也未受影响。
