Department of Human Reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
J Obstet Gynaecol. 2022 Jul;42(5):1293-1300. doi: 10.1080/01443615.2021.1959536. Epub 2021 Sep 29.
We performed a retrospective cohort study, namely "Surgery and ART for Endometriomas" (SAFE) trial (Clinical Trial ID: NCT03717870), including women who underwent laparoscopic cystectomy for endometrioma before first IVF and compared their reproductive outcomes with the ones of women without endometriosis and with unexplained infertility, tubal factor or male factor infertility. We found that women who underwent previous laparoscopic cystectomy for endometrioma had higher FSH and LH levels between the 2nd and 5th day of the cycle before IVF, required higher doses of gonadotrophins for ovarian stimulation and had a lower number of retrieved oocytes compared with other types of infertility. Nevertheless, pregnancy and delivery rates remain comparable to other causes of infertility. In addition, differences in ovarian stimulation parameters between endometriosis and other types of infertility lost significance with the increase of women's age. These pieces of information can be considered useful to make adequate counselling about reproductive outcomes for infertile women with ovarian endometriomas and allow a proper decision-making approach shared with the patient.IMPACT STATEMENT Although endometriomas are common findings in infertile women, whether they should be surgically removed before an fertilisation (IVF) is a long-lasting debate, and current evidence does not offer a robust background to draw firm recommendations. Women who underwent previous laparoscopic cystectomy for endometrioma need higher doses of gonadotrophins for ovarian stimulation and have a lower number of retrieved oocytes, compared with other types of infertility. Pregnancy and delivery rates remain comparable to other causes of infertility. These pieces of information can help to make adequate counselling about reproductive outcomes for infertile women with ovarian endometriomas and allow a proper decision-making approach shared with the patient.
我们进行了一项回顾性队列研究，即“Surgery and ART for Endometriomas”（SAFE）试验（临床试验 ID：NCT03717870），纳入了在首次体外受精（IVF）前行腹腔镜卵巢囊肿切除术治疗子宫内膜异位症的女性，并将其生殖结局与无子宫内膜异位症、不明原因不孕、输卵管因素不孕和男性因素不孕的女性进行比较。我们发现，与其他类型不孕的女性相比，既往行腹腔镜卵巢囊肿切除术治疗子宫内膜异位症的女性在 IVF 前的第 2-5 天的 FSH 和 LH 水平更高，需要更高剂量的促性腺激素进行卵巢刺激，并且获得的卵母细胞数量更少。然而，妊娠和分娩率与其他不孕原因仍相当。此外，随着女性年龄的增加，子宫内膜异位症和其他类型不孕之间的卵巢刺激参数差异失去了意义。这些信息可被视为对卵巢子宫内膜异位症不孕妇女生殖结局进行充分咨询的有用信息，并允许与患者共同做出适当的决策。
声明：尽管子宫内膜异位症是不孕妇女的常见病症，但是否应在体外受精（IVF）前进行手术切除仍存在长期争议，目前的证据并不能为制定明确的推荐提供有力的依据。与其他类型不孕的女性相比，既往行腹腔镜卵巢囊肿切除术治疗子宫内膜异位症的女性需要更高剂量的促性腺激素进行卵巢刺激，并且获得的卵母细胞数量更少。然而，妊娠和分娩率与其他不孕原因仍相当。这些信息可帮助对卵巢子宫内膜异位症不孕妇女的生殖结局进行充分咨询，并允许与患者共同做出适当的决策。
