[子宫内膜异位症相关性不孕的辅助生殖技术（ART）管理：法国妇产科与生殖医学国家顾问委员会-法国卫生总署子宫内膜异位症指南]
[Management of assisted reproductive technology (ART) in case of endometriosis related infertility: CNGOF-HAS Endometriosis Guidelines].
作者信息
Santulli P, Collinet P, Fritel X, Canis M, d'Argent E M, Chauffour C, Cohen J, Pouly J L, Boujenah J, Poncelet C, Decanter C, Borghese B, Chapron C
机构信息
Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Inserm U1016, équipe génomique, épigénétiques et physiopathologie de la reproduction, département développement, reproduction, cancer, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France.
Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France; Inserm, U1189-ONCO Thai-image assisted laser therapy for oncology, CHU de Lille, 59000 Lille, France.
出版信息
Gynecol Obstet Fertil Senol. 2018 Mar;46(3):373-375. doi: 10.1016/j.gofs.2018.02.025. Epub 2018 Mar 2.
The management of endometriosis related infertility requires a global approach. In this context, the prescription of an anti-gonadotropic hormonal treatment does not increase the rate of non-ART (assisted reproductive technologies) pregnancies and it is not recommended. In case of endometriosis related infertility, the results of IVF management in terms of pregnancy and birth rates are not negatively affected by the existence of endometriosis. Controlled ovarian stimulation during IVF does not increase the risk of endometriosis associated symptoms worsening, nor accelerate the intrinsic progression of endometriosis and does not increase the rate of recurrence. However, in the context of IVF management for women with endometriosis, pre-treatment with GnRH agonist or with oestrogen/progestin contraception improve IVF outcomes. There is currently no evidence of a positive or negative effect of endometriosis surgery on IVF outcomes. Information on the possibilities of preserving fertility should be considered, especially before surgery.
子宫内膜异位症相关性不孕的管理需要综合考量。在此背景下，使用抗促性腺激素药物治疗并不能提高非辅助生殖技术（ART）的妊娠率，因此不建议使用。对于子宫内膜异位症相关性不孕，体外受精（IVF）治疗在妊娠率和出生率方面的结果不会因子宫内膜异位症的存在而受到负面影响。IVF过程中的控制性卵巢刺激不会增加子宫内膜异位症相关症状恶化的风险，也不会加速子宫内膜异位症的自然进展，且不会增加复发率。然而，在对患有子宫内膜异位症的女性进行IVF治疗时，使用促性腺激素释放激素（GnRH）激动剂或雌激素/孕激素避孕药进行预处理可改善IVF结局。目前尚无证据表明子宫内膜异位症手术对IVF结局有正面或负面影响。应考虑关于保留生育能力可能性的信息，尤其是在手术前。
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