Gasimli Khayal, Akpinar Dilara, Gasimli Bahar, Bachmann Annette, Maczó Norbert, De Wilde Rudy Leon, Naem Antoine, Krentel Harald, Becker Sven, Tahmasbi Rad Morva
Department of Gynecology and Obstetrics, J.W. Goethe-University Frankfurt, Frankfurt, Germany.
Department of Hepatology and Gastroenterology, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany.
Gynecol Obstet Invest. 2024;89(6):453-460. doi: 10.1159/000539142. Epub 2024 May 3.
Endometriosis is a chronic inflammatory disease known to contribute to infertility. Laparoscopic excision of endometriotic lesions represents a standard treatment modality for symptomatic women. Our study aims to assess the potential benefits of laparoscopic excision of endometriosis in patients experiencing infertility associated with the condition, as well as to define the clinical factors that may impact the cumulative pregnancy rate.
In this retrospective analysis, a total of 102 patients with endometriosis-related infertility were enrolled.
MATERIALS, SETTING, METHODS: All participants underwent reproductive surgery and were then categorized into two groups: those who conceived were assigned to group A, while those who did not were assigned to group B. The correlation between clinical factors and pregnancy rate was assessed using the log-rank test, and both univariate and multivariate analyses were conducted utilizing the Cox regression model.
The median age of the patients was 33.5 years, with a median follow-up duration of 70 months. Throughout the study period, 71 patients (69.6%) conceived (group A), while the remaining 31 patients (30.4%) did not conceive (group B), irrespective of the use of Assisted-Reproduction Technologies. The Cox regression model revealed that factors such as the duration of infertility, presence of deep infiltrating endometriosis, bowel endometriosis, rASRM stages, pelvic adhesions, and recurrent disease negatively impacted postoperative conception rates. Conversely, complete excision and coagulation of endometriotic lesions, as well as ablation of ovarian endometriomas, emerged as independent positive predictive factors for postoperative clinical pregnancy.
Limitations of this study is retrospective design of the study, as well as a small number of patients.
Complete excision of endometriosis during reproductive surgery may yield a positive effect and optimize the likelihood of pregnancy in patients with endometriosis-related infertility.
子宫内膜异位症是一种已知会导致不孕的慢性炎症性疾病。腹腔镜切除子宫内膜异位症病灶是有症状女性的标准治疗方式。我们的研究旨在评估腹腔镜切除子宫内膜异位症对患有与该疾病相关不孕症患者的潜在益处，并确定可能影响累积妊娠率的临床因素。
在这项回顾性分析中，共纳入了102例与子宫内膜异位症相关不孕症的患者。
材料、地点、方法：所有参与者均接受了生殖手术，然后被分为两组：受孕者被分配到A组，未受孕者被分配到B组。使用对数秩检验评估临床因素与妊娠率之间的相关性，并使用Cox回归模型进行单变量和多变量分析。
患者的中位年龄为33.5岁，中位随访时间为70个月。在整个研究期间，71例患者（69.6%）受孕（A组），而其余31例患者（30.4%）未受孕（B组），无论是否使用辅助生殖技术。Cox回归模型显示，不孕持续时间、深部浸润性子宫内膜异位症、肠道子宫内膜异位症、rASRM分期、盆腔粘连和复发性疾病等因素对术后受孕率有负面影响。相反，子宫内膜异位症病灶的完全切除和凝固以及卵巢子宫内膜异位囊肿的消融是术后临床妊娠的独立阳性预测因素。
本研究的局限性在于研究的回顾性设计以及患者数量较少。
生殖手术中完全切除子宫内膜异位症可能会产生积极效果，并优化与子宫内膜异位症相关不孕症患者的妊娠可能性。
