Kohl Schwartz Alexandra Sabrina, Wölfler Monika Martina, Mitter Vera, Rauchfuss Martina, Haeberlin Felix, Eberhard Markus, von Orelli Stephanie, Imthurn Bruno, Imesch Patrick, Fink Daniel, Leeners Brigitte
Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland; Division of Gynecological Endocrinology and Reproductive Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.
Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Graz, Graz, Austria; Department of Obstetrics and Gynecology, RWTH Aachen University Hospital, Aachen, Germany.
Fertil Steril. 2017 Nov;108(5):806-814.e2. doi: 10.1016/j.fertnstert.2017.08.025.
To investigate the prevalence of miscarriage in women with endometriosis (WwE) compared with disease-free control women (CW).
Cross-sectional analysis nested in a retrospective observational study (n = 940).
Hospitals and associated private practices.
PATIENT(S): Previously pregnant women (n = 268) within reproductive age in matched pairs.
INTERVENTION(S): Retrospective analysis of surgical reports and self-administered questionnaires.
MAIN OUTCOME MEASURE(S): Rate of miscarriage, subanalysis for fertility status (≤12 vs. >12 months' time to conception), endometriosis stages (revised American Society of Reproductive Medicine classification [rASRM] I/II vs. III/IV) and phenotypic localizations (superficial peritoneal, ovarian, and deep infiltrating endometriosis).
RESULT(S): The miscarriage rate was higher in WwE (35.8% [95% confidence interval 29.6%-42.0%]) compared with CW (22.0% [16.7%-27.0%]); adjusted incidence risk ratio of 1.97 (95% CI 1.41-2.75). This remained significant in subfertile WwE (50.0% [40.7%-59.4%]) vs. CW (25.8% [8.5%-41.2%]) but not in fertile WwE (24.5% [16.3%-31.6%]) vs. CW (21.5% [15.9%-26.8%]). The miscarriage rate was higher in women with milder forms (rASRM I/II 42.1% [32.6%-51.4%] vs. rASRM III/IV 30.8% [22.6%-38.7%], compared with 22.0% [16.7%-27.0%] in CW), and in women with superficial peritoneal endometriosis (42.0% [32.0%-53.9%]) compared with ovarian endometriosis (28.6% [17.7%-38.7%]) and deep infiltrating endometriosis (33.9% [21.2%-46.0%]) compared with CW (22.0% [16.7%-27.0%]).
CONCLUSION(S): Mild endometriosis, as in superficial lesions, is related to a great extent of inflammatory disorder, possibly leading to defective folliculogenesis, fertilization, and/or implantation, presenting as increased risk of miscarriage.
NCT02511626.
研究子宫内膜异位症女性（WwE）与无病对照女性（CW）相比流产的发生率。
嵌套于一项回顾性观察研究（n = 940）中的横断面分析。
医院及相关私人诊所。
年龄匹配的育龄期曾怀孕女性（n = 268）。
对手术报告和自行填写的问卷进行回顾性分析。
流产率，按生育状态（受孕时间≤12个月与>12个月）、子宫内膜异位症分期（美国生殖医学学会修订分类[rASRM]I/II期与III/IV期）以及表型定位（浅表腹膜型、卵巢型和深部浸润型子宫内膜异位症）进行亚组分析。
WwE的流产率（35.8%[95%置信区间29.6%-42.0%]）高于CW（22.0%[16.7%-27.0%]）；调整后的发病风险比为1.97（95%CI 1.41 - 2.75）。在亚生育的WwE（50.0%[40.7%-59.4%]）与CW（25.8%[8.5%-41.2%]）中该差异仍显著，但在生育能力正常的WwE（24.5%[16.3%-31.6%]）与CW（21.5%[15.9%-26.8%]）中不显著。病情较轻类型（rASRM I/II期42.1%[32.6%-51.4%]与rASRM III/IV期30.8%[22.6%-38.7%]，相比CW为22.0%[16.7%-27.0%]）以及浅表腹膜型子宫内膜异位症女性（42.0%[32.0%-53.9%]）的流产率高于卵巢型子宫内膜异位症女性（28.6%[17.7%-38.7%]）和深部浸润型子宫内膜异位症女性（33.9%[21.2%-46.0%]），相比CW为22.0%[16.7%-27.0%]。
轻度子宫内膜异位症，如浅表病变，在很大程度上与炎症紊乱有关，可能导致卵泡发生、受精和/或着床缺陷，表现为流产风险增加。
NCT02511626。
