Department of Obstetrics and Gynecology, "Villa Sofia Cervello" University of Palermo, Palermo, Italy.
Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
Eur J Obstet Gynecol Reprod Biol. 2020 Nov;254:218-225. doi: 10.1016/j.ejogrb.2020.09.045. Epub 2020 Sep 28.
Endometriosis is a common chronic inflammatory disorder, often causing both pain and infertility. It is estimated that 25-50 % of patients undergoing fertility treatments have had endometriosis as it involves an impairment of the ovarian reserve. For these reasons, endometriosis has been highlighted as a condition that may require a fertility preservation procedure, while being benign in nature. The aim of this review is to summarize the current evidence on fertility preservation techniques for patients affected by endometriosis, focusing on the main characteristics of the different approaches. A systematic review of literature was performed by searching in the main electronic databases (MEDLINE, EMBASE, Web of Science, Scopus, ClinicalTrial.gov, OVID and Cochrane Library), from their inception to February 2020 for studies testing fertility preservation (FP) techniques. Only scientific publications in English were included. Risk of Bias Assessment was performed. Eight articles were included in the study: 3 case reports (one paper reporting 2 cases), 1 prospective longitudinal analysis with only 1 reported case with criteria for inclusion in the review, 2 retrospective observational studies and 2 retrospective cohort studies. The results of our analysis showed embryo (1 article), oocyte (4 articles) and ovarian tissue cryopreservation (3 articles) as preservation methods proposed in international literature for patients with endometriosis. Only few authors reported details on successive outcomes. After ovarian tissue transplantation, 1 pregnancy with IVF and 1 case of endocrine function/ovulation recovery were described; six of 16 endometriotic patients, who underwent embryo cryopreservation, experienced livebirths after successive embryo-transfer; in a large series of 485 patients performing oocyte cryopreservation, an overall cumulative live-birth rate/patient of 46.4 % (225 babies) was reported. Based on the risk of premature ovarian failure related to endometriosis, the offer of FP techniques to these patients has significantly increased, as well as the reported experiences in recent medical literature. However, further studies concerning risks, benefits, effectiveness and cost-effectiveness are needed.
子宫内膜异位症是一种常见的慢性炎症性疾病，常导致疼痛和不孕。据估计，接受生育治疗的患者中有 25-50%患有子宫内膜异位症，因为它涉及卵巢储备功能受损。由于这些原因，子宫内膜异位症已被强调为一种可能需要进行生育保存手术的疾病，尽管其性质是良性的。本综述的目的是总结目前关于受子宫内膜异位症影响的患者生育保存技术的证据，重点介绍不同方法的主要特点。通过在主要电子数据库（MEDLINE、EMBASE、Web of Science、Scopus、ClinicalTrials.gov、OVID 和 Cochrane Library）中进行文献系统回顾，从成立到 2020 年 2 月，检索了测试生育保存（FP）技术的研究。仅包括英语的科学出版物。进行了偏倚风险评估。本研究纳入了 8 篇文章：3 篇病例报告（一篇文章报告了 2 例），1 篇仅 1 例符合纳入标准的前瞻性纵向分析，2 篇回顾性观察研究和 2 篇回顾性队列研究。我们的分析结果显示，胚胎（1 篇文章）、卵子（4 篇文章）和卵巢组织冷冻保存（3 篇文章）是国际文献中提出的用于子宫内膜异位症患者的保存方法。只有少数作者详细报告了后续结果。卵巢组织移植后，描述了 1 例 IVF 妊娠和 1 例内分泌功能/排卵恢复；6 例接受胚胎冷冻保存的子宫内膜异位症患者在随后的胚胎移植后经历了活产；在 485 例接受卵子冷冻保存的大系列中，报道了 46.4%（225 例婴儿）的患者总体累积活产率。基于与子宫内膜异位症相关的卵巢早衰风险，向这些患者提供 FP 技术的需求显著增加，并且在最近的医学文献中也有报道。然而，需要进一步研究风险、益处、有效性和成本效益。
