Faculty of Medicine, University of Paris, Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire, Paris, France; Department "Development, Reproduction and Cancer," Cochin Institute, INSERM U1016, Paris, France.
Faculty of Medicine, University of Paris, Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire, Paris, France; Department "Development, Reproduction and Cancer," Cochin Institute, INSERM U1016, Paris, France.
Fertil Steril. 2021 Mar;115(3):692-701. doi: 10.1016/j.fertnstert.2020.09.032. Epub 2020 Dec 1.
To evaluate the assisted reproductive technology (ART) cumulative live-birth rate (LBR) in a cohort of bowel endometriosis patients with no prior history of surgery for endometriosis.
Prospective cohort study.
University hospital.
PATIENT(S): One hundred and one consecutive infertile bowel-endometriosis patients with no prior history of surgery for endometriosis in whom the diagnosis of endometriosis was based on published imaging criteria using transvaginal sonography and magnetic resonance imaging.
INTERVENTION(S): First-line ART.
MAIN OUTCOME MEASURE(S): Cumulative LBR, with statistical analysis via Kaplan Meier method with a "conservative" method, whereby it was assumed that no live births took place for patients who did not return.
RESULT(S): Between January 2016 and December 2018, 101 bowel endometriosis patients underwent 176 ART cycles. The mean number of deep-infiltrating endometriosis lesions per patient was 3 ± 0.9, with a mean number of bowel lesions of 1.3 ± 0.6. Seventy-three percent of the patients had associated endometriomas, and 88.1% had associated adenomyosis. Overall, the cumulative LBR after four ART cycles was 64.4%, using the conservative Kaplan-Meier method.
CONCLUSION(S): The ART cumulative LBR was very satisfactory (64.4%) in bowel endometriosis patients with no prior history of surgery for endometriosis. In light of these data, clinicians should carefully weigh the pros and cons before systematically referring infertile bowel endometriosis patients to fertility-preserving surgery because as first-line ART appears to offer satisfactory results.
评估无既往子宫内膜异位症手术史的肠子宫内膜异位症患者队列中的辅助生殖技术（ART）累计活产率（LBR）。
前瞻性队列研究。
大学医院。
101 例连续的不孕肠子宫内膜异位症患者，无既往子宫内膜异位症手术史，其子宫内膜异位症的诊断基于发表的影像学标准，使用经阴道超声和磁共振成像。
一线 ART。
累积 LBR，采用 Kaplan-Meier 法进行统计分析，并采用“保守”方法，即假设未返回的患者未发生活产。
2016 年 1 月至 2018 年 12 月，101 例肠子宫内膜异位症患者接受了 176 个 ART 周期。每位患者的深部浸润性子宫内膜异位症病变的平均数量为 3±0.9，肠病变的平均数量为 1.3±0.6。73%的患者伴有子宫内膜异位瘤，88.1%伴有子宫腺肌病。总体而言，采用保守的 Kaplan-Meier 方法，4 个 ART 周期后的累积 LBR 为 64.4%。
无既往子宫内膜异位症手术史的肠子宫内膜异位症患者的 ART 累积 LBR 非常令人满意（64.4%）。鉴于这些数据，临床医生在系统地将不孕肠子宫内膜异位症患者转介到保留生育力手术之前，应仔细权衡利弊，因为作为一线 ART 似乎可以提供令人满意的结果。
