Liang Ying, Liu Min, Zhang Jianmei, Mao Zenghui
Reproductive Center of Changsha Hospital for Maternal and Child Health Care, Changsha, China.
Hunan Key Laboratory of Regional Hereditary Birth Defects Prevention and Control, Changsha Hospital for Maternal Child Health Care Affiliated to Hunan Normal University, Changsha, China.
Front Endocrinol (Lausanne). 2024 Apr 18;15:1352770. doi: 10.3389/fendo.2024.1352770. eCollection 2024.
The efficiency of different first-line treatments, such as first-line surgery and assisted reproductive technology (ART), in women with deep infiltrating endometriosis (DIE) is still unclear due to a lack of direct comparative trials. This systematic review and meta-analysis aim to elucidate and compare the efficacies of first-line treatments in patients with DIE, with an emphasis on fertility outcomes.
An exhaustive search of PubMed Central, SCOPUS, EMBASE, MEDLINE, Cochrane trial registry, Google Scholar, and Clinicaltrials.gov databases was done to identify studies directly comparing first-line surgery and assisted reproductive technology (ART) for DIE, and reporting fertility-related outcomes. Pooled estimates for each of the binary outcomes were reported as odds ratios (ORs) with 95% confidence intervals (CIs). The results were pooled using a random-effects model with the Mantel-Haenszel technique.
Our results show that pregnancy rate per patient (OR, 1.47; 95% CI, 0.59 to 3.63), pregnancy rate per cycle (OR, 1.16; 95% CI, 0.45 to 2.99), and live births per patient (OR, 1.66; 95% CI, 0.56 to 4.91) were comparable in DIE patients, treated with surgery or ART as a first line of treatment. When both complete and incomplete surgical DIE excision procedures were taken into account, surgery was associated with a significant enhancement in the pregnancy rate per patient (OR, 1.63; 95% CI, 1.11 to 2.40).
The available evidence suggests that both first-line surgery and ART can be effective DIE treatments with similar fertility outcomes. However, further analysis reveals that excluding studies involving endometriomas significantly alters the understanding of treatment efficacy between surgery and ART for DIE-associated infertility.
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=426061, identifier CRD42023426061.
由于缺乏直接的对比试验，不同一线治疗方法，如一线手术和辅助生殖技术（ART），对深部浸润性子宫内膜异位症（DIE）女性患者的疗效仍不明确。本系统评价和荟萃分析旨在阐明并比较DIE患者一线治疗方法的疗效，重点关注生育结局。
对PubMed Central、SCOPUS、EMBASE、MEDLINE、Cochrane试验注册库、谷歌学术和Clinicaltrials.gov数据库进行全面检索，以识别直接比较DIE的一线手术和辅助生殖技术（ART）并报告生育相关结局的研究。每个二元结局的合并估计值以比值比（OR）及95%置信区间（CI）报告。采用随机效应模型和Mantel-Haenszel技术对结果进行合并。
我们的结果表明，作为一线治疗方法，手术或ART治疗的DIE患者的每位患者妊娠率（OR，1.47；95%CI，0.59至3.63）、每个周期妊娠率（OR，1.16；95%CI，0.45至2.99）和每位患者活产率（OR，1.66；95%CI，0.56至4.91）相当。当考虑完全和不完全手术DIE切除程序时，手术与每位患者妊娠率的显著提高相关（OR，1.63；95%CI，1.11至2.40）。
现有证据表明，一线手术和ART都是有效的DIE治疗方法，生育结局相似。然而，进一步分析显示，排除涉及子宫内膜瘤的研究显著改变了对手术和ART治疗DIE相关性不孕症疗效的理解。
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=426061，标识符CRD42023426061。
