Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, 90127, Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127, Palermo, Italy.
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127, Palermo, Italy; Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", 80131, Naples, Italy.
Best Pract Res Clin Obstet Gynaecol. 2024 Sep;96:102524. doi: 10.1016/j.bpobgyn.2024.102524. Epub 2024 Jun 18.
In women with proven infertility and deep endometriosis (DE), optimal management is controversial. To date, there is no clear evidence on the association between infertility and different stages of rASRM, nor is there clear guidance from leading scientific societies for surgical treatment of DE patients. A comprehensive literature search was conducted on the main databases for English-language trials describing the effectiveness of surgery for DE in patients with proven infertility; 16 studies were deemed eligible for inclusion in this systematic review (CRD42024498888). Quantitative analysis was not possible because of the heterogeneity of the data. A descriptive summary of the results according to location of pathology, surgical technique used, and whether assisted reproductive technology (ART) was needed or not was provided. A total of 947 infertile women were identified, 486 of whom became pregnant, with an average pregnancy rate of 51.3%. Our review suggests that surgery can be of valuable help in improving reproductive outcomes by improving the results of ART. It has not been possible to reach robust conclusions on the outcomes of surgery based on the location of DE because of the heterogeneity of evidence available to date. Overall, although some data encourage first-line surgical management, further investigation is needed to determine its effective application before or after ART failure.
对于已确诊不孕症且深部子宫内膜异位症（DE）的女性，其最佳管理方案存在争议。迄今为止，尚无明确证据表明不孕症与 rASRM 的不同阶段之间存在关联，也没有主要科学协会针对 DE 患者的手术治疗提供明确指导。对描述不孕症患者 DE 手术有效性的英文试验进行了主要数据库的全面文献检索；有 16 项研究被认为符合纳入本系统评价的标准（CRD42024498888）。由于数据的异质性，无法进行定量分析。根据病变部位、使用的手术技术以及是否需要辅助生殖技术（ART）提供了结果的描述性总结。共确定了 947 名不孕女性，其中 486 名怀孕，平均妊娠率为 51.3%。我们的综述表明，手术可以通过改善 ART 的结果，为改善生殖结局提供有价值的帮助。由于迄今为止可用证据的异质性，无法根据 DE 的位置得出关于手术结果的可靠结论。总体而言，尽管有一些数据鼓励一线手术治疗，但需要进一步研究以确定其在 ART 失败前后的有效应用。
