Bila Jovan, Vidakovic Snezana, Spremovic Radjenovic Svetlana, Dotlic Jelena, Tulic Lidija, Stojnic Jelena, Micic Jelena, Tinelli Andrea
Clinic of Obstetrics and Gynecology University Clinical Center of Serbia, Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Ginekol Pol. 2022;93(10):827-834. doi: 10.5603/GP.a2022.0093.
To evaluate the impact of pharmacological and surgical endometriosis treatment on IVF reproductive outcomes in patients with primary infertility.
The study, conducted over a five year period, included 73 patients with endometriosis associated primary infertility subjected to 77 cycles. Group I included patients treated for endometriosis before the IVF (subgroups A: surgical and pharmacological treatment and B: only surgical treatment). Group II included patients immediately subjected to IVF. Assessed outcomes were pregnancy rate (PR) per started cycle, fertilization rate (FR), implantation rate (IR) and live birth rate (LBR).
Group IA included 25 patients, Group IB 21 and Group II 27 patients. FR and IR showed no significant differences between groups. PR was significantly higher in the Group I than Group II (49% vs 25%, p = 0.030). PR per started cycle was the highest in the Group IA and the lowest in the Group II (p = 0.040). LBR was significantly higher in whole Group I (p = 0.043) and subgroup IA (p = 0.020) than Group II. Group IA and IB did not differ regarding examined outcomes. Regression analysis showed that endometriosis pretreatment method can impact both achieving pregnancy (p = 0.036) and having a live born child (p = 0.008) after IVF. The combined surgical and pharmacological endometriosis treatment, shorter infertility duration, lower EFI score, using long protocol with FSH+HMG gonadotropins increase the probability of successful IVF.
A combined surgical and pharmacological endometriosis treatment had a positive impact on IVF reproductive outcomes, both on pregnancy and on live birth rates.
评估药物和手术治疗子宫内膜异位症对原发性不孕患者体外受精（IVF）生殖结局的影响。
本研究历时五年，纳入73例患有子宫内膜异位症相关原发性不孕的患者，共进行了77个周期的治疗。第一组包括在IVF前接受子宫内膜异位症治疗的患者（A亚组：手术和药物联合治疗；B亚组：仅手术治疗）。第二组包括直接接受IVF的患者。评估的结局指标为每个启动周期的妊娠率（PR）、受精率（FR）、着床率（IR）和活产率（LBR）。
第一组A亚组有25例患者，第一组B亚组有21例患者，第二组有27例患者。各组之间的FR和IR无显著差异。第一组的PR显著高于第二组（49%对25%，p = 0.030）。每个启动周期的PR在第一组A亚组中最高，在第二组中最低（p = 0.040）。整个第一组（p = 0.043）和第一组A亚组（p = 0.020）的LBR显著高于第二组。第一组A亚组和B亚组在检查的结局方面没有差异。回归分析表明，子宫内膜异位症预处理方法会影响IVF后妊娠（p = 0.036）和活产（p = 0.008）的几率。子宫内膜异位症的手术和药物联合治疗、较短的不孕持续时间、较低的子宫内膜因子指数（EFI）评分、使用FSH + HMG促性腺激素的长方案可提高IVF成功的概率。
子宫内膜异位症的手术和药物联合治疗对IVF生殖结局有积极影响，对妊娠率和活产率均有提高。
