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子宫内膜异位症病灶的定位对卵巢储备及辅助生殖技术结局的影响。

The impact of the localisation of endometriosis lesions on ovarian reserve and assisted reproduction techniques outcomes.

作者信息

Ashrafi Mahnaz, Arabipoor Arezoo, Hemat Mandana, Salman-Yazdi Reza

机构信息

a Department of Endocrinology and Female Infertility , Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR , Tehran , Iran.

b Department of Obstetrics and Gynecology, School of Medicine , Iran University of Medical Science , Tehran , Iran.

出版信息

J Obstet Gynaecol. 2019 Jan;39(1):91-97. doi: 10.1080/01443615.2018.1465898. Epub 2018 Sep 26.

Abstract

This case-control study was designed to evaluate the impact of endometriosis and the presence of endometrioma (OMA) per se on the serum anti-Müllerian hormone (AMH) level and also to compare the in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) outcomes after therapeutic surgery in endometriosis patients, according to the localisation of endometriosis lesions. One hundred and fifty two infertile women ≤40 years with suspicious symptoms were surgically evaluated to detect the aetiology of infertility at the Royan Institute during this study and, in parallel, 131 patients with a male factor infertility diagnosis were considered as the control group. The serum AMH level and IVF/ICSI outcomes were compared according to the nature and extension degree of endometriosis lesions. The results demonstrated that the existence of a deep infiltrating endometriosis (DIE) with and without OMA was associated with a significant decrease in AMH level, antral follicle count and ovarian sensitivity index (OSI) (p < .001 and p = .007, respectively). The multivariable logistic regression analysis adjusted for confounding factors indicated that the OSI and the existence of DIE with and without OMA were a significant predictive variable for clinical pregnancy and for live birth. On the basis of our results, the severity of endometriosis and the location of its lesions could affect an ovarian reserve and the ovarian stimulation outcomes. Impact Statement What is already known on this subject? Previous studies have evaluated the impact of endometrioma (OMA) on ovarian reserve and the assisted reproduction technology (ART) outcomes and controversial results have been reported; therefore, it seems that this topic still needs further research. What the results of this study add? In the present study, the effect of endometriosis lesions' localisation on ovarian reserve and the success rate of the in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) cycle after therapeutic surgery were compared with that of the control group. It was found that the existence of a deep infiltrating endometriosis (DIE) with and without OMA was associated with a significant decrease in the anti-Müllerian hormone (AMH) level, antral follicle count, ovarian sensitivity index (OSI), clinical pregnancy and live birth rates. What the implications are of these findings for clinical practice and/or further research? The results of this study has a practical value in the decision making process for the ovarian stimulation protocol in patients with the different severity of endometriosis and the counselling regarding the success rate of IVF or ICSI/embryo transfer cycles.

摘要

本病例对照研究旨在评估子宫内膜异位症及子宫内膜瘤(OMA)本身对血清抗苗勒管激素(AMH)水平的影响,并根据子宫内膜异位症病变的位置,比较子宫内膜异位症患者治疗性手术后的体外受精/卵胞浆内单精子注射(IVF/ICSI)结局。在本研究期间,对152名年龄≤40岁、有可疑症状的不孕女性进行了手术评估,以检测罗扬研究所不孕的病因,同时,将131名诊断为男性因素不孕的患者作为对照组。根据子宫内膜异位症病变的性质和扩展程度,比较血清AMH水平和IVF/ICSI结局。结果表明,伴有或不伴有OMA的深部浸润性子宫内膜异位症(DIE)的存在与AMH水平、窦卵泡计数和卵巢敏感性指数(OSI)的显著降低相关(分别为p<0.001和p = 0.007)。针对混杂因素进行调整的多变量逻辑回归分析表明,OSI以及伴有或不伴有OMA的DIE的存在是临床妊娠和活产的重要预测变量。根据我们的结果,子宫内膜异位症的严重程度及其病变位置可能会影响卵巢储备和卵巢刺激结局。影响声明关于该主题已知的信息有哪些?先前的研究评估了子宫内膜瘤(OMA)对卵巢储备和辅助生殖技术(ART)结局的影响,并且报道了有争议的结果;因此,似乎该主题仍需要进一步研究。本研究的结果增加了什么?在本研究中,将子宫内膜异位症病变的位置对卵巢储备以及治疗性手术后体外受精/卵胞浆内单精子注射(IVF/ICSI)周期成功率的影响与对照组进行了比较。发现伴有或不伴有OMA的深部浸润性子宫内膜异位症(DIE)的存在与抗苗勒管激素(AMH)水平、窦卵泡计数、卵巢敏感性指数(OSI)、临床妊娠率和活产率的显著降低相关。这些发现对临床实践和/或进一步研究有何意义?本研究结果在针对不同严重程度子宫内膜异位症患者的卵巢刺激方案决策过程以及关于IVF或ICSI/胚胎移植周期成功率的咨询方面具有实际价值。

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