Kolanska K, Cohen J, Bendifallah S, Selleret L, Antoine J-M, Chabbert-Buffet N, Darai E, d'Argent E-M
Department of Gynecology and Obstetrics, Tenon Hospital, Assistance publique-Hôpitaux de Paris, Pierre-et-Marie-Curie University (UMPC)-Paris 6, 75020 Paris, France; UMRS-938, Pierre-et-Marie-Curie University-Paris 6, 75020 Paris, France; Clinical Research Group (GRC-6 UPMC): Centre expert en endométriose (C3E), Tenon Hospital, Pierre-et Marie-Curie-University (UMPC)-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France.
Department of Gynecology and Obstetrics, Tenon Hospital, Assistance publique-Hôpitaux de Paris, Pierre-et-Marie-Curie University (UMPC)-Paris 6, 75020 Paris, France; UMRS-938, Pierre-et-Marie-Curie University-Paris 6, 75020 Paris, France; Clinical Research Group (GRC-6 UPMC): Centre expert en endométriose (C3E), Tenon Hospital, Pierre-et Marie-Curie-University (UMPC)-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France.
J Gynecol Obstet Hum Reprod. 2017 Nov;46(9):681-686. doi: 10.1016/j.jogoh.2017.09.007. Epub 2017 Sep 29.
Endometriosis is common in women referred for infertility. In vitro fertilization provides good results but the choice of the best-controlled ovarian hyperstimulation protocol remains a subject of debate. The objective of this retrospective study was to compare pregnancy outcomes in women with endometriosis-associated infertility after COH with a long agonist protocol or a six-week oral contraception-antagonist protocol.
Retrospective analysis of a prospective database identified 284 COH cycles - 165 with GnRH-agonist protocol (GnRH-agonist group) and 119 with GnRH-antagonist protocol (GnRH-antagonist group) - in 218 women, with endometriosis from January 2013 to October 2015.
No difference in the epidemiological characteristics was found between the groups. Per started cycle, pregnancy and live-birth rates after fresh embryo transfer were higher with the GnRH-agonist protocol (25% vs. 13%, P=0.02 and 18% vs. 8%, P=0.04, respectively). Considering analysis per cycle with embryo transfer, the pregnancy rate was similar in both groups while the live-birth rate was higher in the GnRH-agonist group (29% vs. 17%, P=0.053 and 22% vs. 10%, P=0.02, respectively). No difference was observed between the groups with freeze-thaw embryo transfer. Subgroup analysis (endometrioma alone, deep infiltrating endometriosis with and without endometrioma, endometriosis with and without adenomyosis) revealed no difference between the groups for either pregnancy or live-birth rates.
A GnRH-agonist protocol appears to result in higher pregnancy and live-birth rates after fresh embryo transfer in women with endometriosis-associated infertility, suggesting that a GnRH-antagonist protocol might negatively impact endometrial receptivity.
子宫内膜异位症在因不孕症就诊的女性中很常见。体外受精效果良好，但最佳控制性卵巢刺激方案的选择仍存在争议。这项回顾性研究的目的是比较采用长效激动剂方案或六周口服避孕药-拮抗剂方案进行控制性卵巢刺激（COH）后，子宫内膜异位症相关性不孕症女性的妊娠结局。
对一个前瞻性数据库进行回顾性分析，确定了2013年1月至2015年10月期间218例患有子宫内膜异位症的女性中的284个COH周期——165个采用促性腺激素释放激素激动剂方案（GnRH-激动剂组），119个采用促性腺激素释放激素拮抗剂方案（GnRH-拮抗剂组）。
两组之间的流行病学特征没有差异。每个启动周期，新鲜胚胎移植后的妊娠率和活产率在GnRH-激动剂方案组更高（分别为25%对13%，P=0.02；18%对8%，P=0.04）。考虑每个有胚胎移植的周期进行分析，两组的妊娠率相似，而GnRH-激动剂组的活产率更高（分别为29%对17%，P=0.053；22%对10%，P=0.02）。冻融胚胎移植组之间未观察到差异。亚组分析（仅子宫内膜异位囊肿、有或无子宫内膜异位囊肿的深部浸润性子宫内膜异位症、有或无子宫腺肌病的子宫内膜异位症）显示，两组之间的妊娠率或活产率均无差异。
GnRH-激动剂方案似乎能使子宫内膜异位症相关性不孕症女性在新鲜胚胎移植后获得更高的妊娠率和活产率，这表明GnRH-拮抗剂方案可能会对子宫内膜容受性产生负面影响。
