Department of Gynaecology, Obstetric and Reproductive Medicine, AP-HM, La Conception University Hospital, Marseille, France.
Public Health Department, AP-HM, Aix Marseille University, Marseille, France.
Reprod Biomed Online. 2023 Sep;47(3):103186. doi: 10.1016/j.rbmo.2023.02.012. Epub 2023 Mar 4.
Does moderate-to-severe endometriosis have an impact on cumulative live birth rates (cLBR) and IVF outcomes?
In this retrospective matched cohort study, women with moderate-to-severe endometriosis undergoing IVF or intracytoplasmic sperm injection treatment from January 2015 to December 2020 were matched 1:2 to women with other causes of infertility (control group). The main outcome was cLBR per cycle and per woman, and secondary outcomes were number of oocytes retrieved and number of mature oocytes, fertilization rate, total number of embryos and usable embryos, implantation rate, clinical pregnancy rate and miscarriage rate per cycle.
In total, 195 women with endometriosis were matched with 390 women without endometriosis (323 and 646 cycles, respectively). Women with endometriosis had significantly fewer oocytes retrieved than women in the control group (P=0.003) despite higher doses of gonadotropins, but had a similar number of mature oocytes, fertilization rate, and total number of embryos and usable embryos. cLBR per cycle and per women did not differ significantly between the endometriosis group and the control group (19.8% versus 24.3%, P = 0.12; 32.3% versus 37.2%, P = 0.24, respectively). In women with endometrioma, a history of cystectomy did not impact cLBR per cycle (28.3% versus 31.9%, P = 0.68). We did not observe any significant impact of tobacco use in the endometriosis group compared with the control group (16.4% versus 25.9%, P = 0.13).
This matched cohort study did not observe a significant impact of moderate-to-severe endometriosis on cLBR among women undergoing IVF. These data are reassuring for the counselling of infertile women with endometriosis before IVF.
中重度子宫内膜异位症是否会影响累积活产率（cLBR）和 IVF 结局？
在这项回顾性匹配队列研究中，2015 年 1 月至 2020 年 12 月期间接受 IVF 或胞浆内精子注射治疗的中重度子宫内膜异位症女性与其他不孕原因（对照组）的女性按 1:2 匹配。主要结局是每周期和每位女性的 cLBR，次要结局是取卵数和成熟卵数、受精率、胚胎总数和可用胚胎数、着床率、每周期临床妊娠率和流产率。
共有 195 名子宫内膜异位症女性与 390 名无子宫内膜异位症女性（分别为 323 和 646 个周期）进行了匹配。尽管使用了更高剂量的促性腺激素，但子宫内膜异位症女性的取卵数明显少于对照组（P=0.003），但成熟卵数、受精率、胚胎总数和可用胚胎数相似。每周期和每位女性的 cLBR 在子宫内膜异位症组和对照组之间没有显著差异（19.8%比 24.3%，P=0.12；32.3%比 37.2%，P=0.24）。在有子宫内膜瘤的女性中，既往行囊肿切除术不影响每周期的 cLBR（28.3%比 31.9%，P=0.68）。与对照组相比，我们没有观察到子宫内膜异位症组吸烟的任何显著影响（16.4%比 25.9%，P=0.13）。
这项匹配队列研究没有观察到中重度子宫内膜异位症对接受 IVF 的女性 cLBR 的显著影响。这些数据为接受 IVF 的子宫内膜异位症不孕女性提供了令人安心的咨询信息。
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