体外受精/卵胞浆内单精子注射前剥除卵巢子宫内膜异位囊肿对卵巢储备功能的利弊权衡：一项荟萃分析
Weigh the pros and cons to ovarian reserve before stripping ovarian endometriomas prior to IVF/ICSI: A meta-analysis.
作者信息
Tao Xin, Chen Lei, Ge Shuqi, Cai Lisi
机构信息
Center for Reproductive Medicine, the Third Affiliated Hospital of Sun-Yet Sen University, Guangzhou, Guangdong Province, China.
Department of Infertility and Sexual Medicine, the Third Affiliated Hospital of Sun-Yet Sen University, Guangzhou, Guangdong Province, China.
出版信息
PLoS One. 2017 Jun 2;12(6):e0177426. doi: 10.1371/journal.pone.0177426. eCollection 2017.
PURPOSE
To explore the effects of conservative surgery for endometriomas on ovarian responsiveness during assisted reproductive technology (ART) and provide reproductive and gynecological doctors with a more reliable reference program for the treatment of endometriomas.
METHODS
A literature search was performed by searching the PubMed, Embase, Cochrane Library, Web of Science and Science Direct databases. Studies with inter- and intra-patient comparisons of ovarian responses and oocyte quality between operated and unoperated ovaries and that met the inclusion criteria were retrieved, and the data from the outcome measures were extracted and pooled for this meta-analysis.
RESULTS
Twenty-one published studies (2649 ART cycles) were included. The total amount of gonadotropin (Gn) used (inverse variance (IV):0.48; 95% confidence interval (CI): [0.13, 1.82], P = 0.0007) was significantly increased in the women with endometriomas who had a history of cystectomy. The estrogen (E) level on the day of hCG administration (IV: -0.29; 95% CI: [-0.41, -0.17], P<0.00001), the number of mature or dominant follicles (IV: -1.17; 95% CI: [-1.51, -0.82], P<0.00001) and the total number of oocytes retrieved (IV: -1.78; 95% CI: [-2.38, -1.17], P<0.00001) were significantly decreased in the women with endometriomas who had a history of cystectomy. The duration of stimulation (IV: 0.02; 95% CI: [-0.09, 0.13], P = 0.77), the total number of formed embryos (IV: -0.06; 95% CI: [-0.17, 0.04], P = 0.25), the pregnancy rate(IV:0.98;95%CI[0.82,1.18], P = 0.83) and the live birth rate(IV:0.93;95%CI[0.70,1.23], P = 0.61)were not statistically different between the two groups. Similar intra-patient results were found in the number of mature or dominant follicles (IV: -0.88; 95% CI: [-1.25, -0.52], P<0.00001) and the total number of oocytes retrieved (IV: -3.48; 95% CI: [-4.77, -2.19], P<0.00001).
CONCLUSION
ART might be a better therapeutic method for ovarian endometrioma-related infertility than cystectomy.
目的
探讨子宫内膜异位囊肿保守性手术对辅助生殖技术（ART）中卵巢反应性的影响，为生殖及妇科医生治疗子宫内膜异位囊肿提供更可靠的参考方案。
方法
通过检索PubMed、Embase、Cochrane图书馆、Web of Science和Science Direct数据库进行文献检索。检索符合纳入标准的、对手术和未手术卵巢的卵巢反应及卵母细胞质量进行患者间和患者内比较的研究，并提取来自结局指标的数据进行汇总，用于本荟萃分析。
结果
纳入21项已发表研究（2649个ART周期）。有囊肿切除术史的子宫内膜异位症女性使用促性腺激素（Gn）的总量显著增加（逆方差（IV）：0.48；95%置信区间（CI）：[0.13, 1.82]，P = 0.0007）。有囊肿切除术史的子宫内膜异位症女性在注射人绒毛膜促性腺激素（hCG）当天的雌激素（E）水平显著降低（IV：-0.29；95%CI：[-0.41, -0.17]，P<0.00001），成熟或优势卵泡数量显著减少（IV：-1.17；95%CI：[-1.51, -0.82]，P<0.00001），回收的卵母细胞总数显著减少（IV：-1.78；95%CI：[-2.38, -1.17]，P<0.00001）。两组间刺激持续时间（IV：0.02；95%CI：[-0.09, 0.13]，P = 0.77）、形成胚胎总数（IV：-0.06；95%CI：[-0.17, 0.04]，P = 0.25）、妊娠率（IV：0.98；95%CI[0.82, 1.18]，P = 0.83）和活产率（IV：0.93；95%CI[0.70, 1.23]，P = 0.61）无统计学差异。在成熟或优势卵泡数量（IV：-0.88；95%CI：[-1.25, -0.52]，P<0.00001）和回收的卵母细胞总数（IV：-3.48；95%CI：[-4.77, -2.19]，P<0.00001）方面，患者内结果相似。
结论
对于卵巢子宫内膜异位症相关不孕症，ART可能是比囊肿切除术更好的治疗方法。
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