Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan (Drs. Kuroda, Nakagawa, and Sugiyama); Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan (Drs. Kuroda, Ikemoto, Ochiai, Ozaki, and Matsumura).
Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan (Drs. Kuroda, Ikemoto, Ochiai, Ozaki, and Matsumura).
J Minim Invasive Gynecol. 2019 Nov-Dec;26(7):1369-1375. doi: 10.1016/j.jmig.2019.02.008. Epub 2019 Feb 19.
To analyze the clinical outcomes of and predictive factors for the therapeutic effect of combination treatment of preoperative embryo cryopreservation and endoscopic surgery (surgery-assisted reproductive technology [ART] hybrid therapy) in infertile women with diminished ovarian reserve (DOR) with uterine fibroids and/or ovarian endometriomas.
Retrospective cohort study.
Data from all patients who underwent surgery-ART hybrid therapy at Juntendo University Hospital and Sugiyama Clinic between 2014 and 2016 were analyzed retrospectively. We compared women who experienced live birth (success group) and implantation failure or miscarriage (failure group) after surgery-ART hybrid therapy and evaluate the predictive factors for live birth.
A total of 39 infertile women underwent surgery-ART hybrid therapy with 86 embryo transfer cycles.
All women underwent ART treatment for embryo cryopreservation preoperatively, reproductive surgery, and warmed embryo transfer after the postoperative contraceptive interval (surgery-ART hybrid therapy) for women with DOR (anti-Müllerian hormone <1.0 ng/mL) and/or advanced reproductive age (>40 years) with uterine myomas and/or ovarian endometriomas who required surgery.
Among 39 women underwent surgery-ART hybrid therapy, 1 woman acquired no embryo after oocyte retrieval trials and abandoned efforts to conceive, 14 experienced childbirth (success group) and 24 (63.2%) experienced implantation failure or miscarriage (failure group) after surgery-ART hybrid therapy. The median patient age was 40 years (interquartile range [IQR], 38-41 years) in the success group and 41.5 years (IQR, 41-42 years) in the failure group (p = .032). The respective serum anti-Müllerian hormone levels were 2.5 ng/mL (range, 0.1-8.6 ng/mL) and 1.3 ng/mL (range, 0.1-4.2 ng/mL) (p = .396), and the respective numbers of preoperative frozen were 5.0 (range, 4.0-6.0) and 2.0 (range, 1.0-3.0) (p < .001). There were no significant differences in surgical findings of myomas and endometriosis between the 2 groups. Compared with the 24 women who experienced hybrid therapy failure, the 14 who underwent successful surgery-ART hybrid therapy were significantly younger and had a greater number of cryopreserved embryos.
Successful surgery-ART hybrid therapy requires a sufficient preoperative age-specific number of frozen embryos, establishment of ART treatment with stable pregnancy outcomes and skillful reproductive surgery, and a strong desire of the patient and doctor for pregnancy.
分析在患有卵巢储备功能降低（DOR）合并子宫肌瘤和/或卵巢子宫内膜异位症的不孕妇女中，行术前胚胎冷冻和内镜手术（手术辅助生殖技术[ART]联合治疗）的临床结局和治疗效果的预测因素。
回顾性队列研究。
本研究回顾性分析了 2014 年至 2016 年期间在顺天堂大学医院和杉山诊所接受手术-ART 联合治疗的所有患者的数据。我们比较了行手术-ART 联合治疗后活产（成功组）和种植失败或流产（失败组）的患者，并评估了活产的预测因素。
共 39 名患有 DOR（抗苗勒氏管激素<1.0ng/mL）和/或高龄（>40 岁）合并子宫肌瘤和/或卵巢子宫内膜异位症的不孕妇女接受了手术-ART 联合治疗，共进行了 86 个胚胎移植周期。所有患者均行 ART 治疗进行术前胚胎冷冻，在术后避孕间隔期（手术-ART 联合治疗）后进行生殖手术和冻融胚胎移植。
在 39 名接受手术-ART 联合治疗的患者中，1 名患者在取卵试验后未获得胚胎并放弃了妊娠尝试，14 名患者分娩（成功组），24 名患者（63.2%）在手术-ART 联合治疗后发生种植失败或流产（失败组）。成功组患者的中位年龄为 40 岁（四分位距[IQR]，38-41 岁），失败组为 41.5 岁（IQR，41-42 岁）（p=0.032）。两组患者的血清抗苗勒氏管激素水平分别为 2.5ng/mL（范围，0.1-8.6ng/mL）和 1.3ng/mL（范围，0.1-4.2ng/mL）（p=0.396），术前冷冻胚胎数分别为 5.0（范围，4.0-6.0）和 2.0（范围，1.0-3.0）（p<0.001）。两组患者的子宫肌瘤和子宫内膜异位症的手术发现无显著差异。与 24 名发生联合治疗失败的患者相比，14 名成功行手术-ART 联合治疗的患者年龄显著较小，冷冻胚胎数量更多。
成功的手术-ART 联合治疗需要有足够的、符合年龄的冷冻胚胎数量，建立具有稳定妊娠结局的 ART 治疗，并需要患者和医生强烈的妊娠愿望。
