Department of Obstetrics Gynecology and Reproductive Medicine, ART Unit, Poissy Saint-Germain-en-Laye Hospital, Poissy, France.
Department of Obstetrics Gynecology and Reproductive Medicine, ART Unit, Poissy Saint-Germain-en-Laye Hospital, Poissy, France; RHuMA team, UMR1198-BREDD, UVSQ, INRAE, ENVA, UFR-SVS, UVSQ, Montigny le bretonneux.
J Gynecol Obstet Hum Reprod. 2024 Dec;53(10):102835. doi: 10.1016/j.jogoh.2024.102835. Epub 2024 Aug 14.
What is the impact of ethanol sclerotherapy of endometriomas prior to IVF/ICSI on pregnancy rates?
We reviewed women with endometrioma(s) larger than 25 mm having IVF/ICSI cycles. All patients with a history of ovarian cystectomy were excluded. Two groups were compared: patients who had transvaginal ethanol sclerotherapy of their endometrioma(s) before ovarian stimulation and patients whose endometrioma(s) were left in situ (untreated) at the time of IVF/ICSI (control group). Analyses were adjusted for confounding factors by inverse probability of treatment weighting. The primary endpoint was progressive pregnancy rates per IVF/ICSI cycle including fresh and frozen embryo transfers. Secondary endpoints were live birth rates, the number of mature oocytes retrieved, pregnancy loss. Endometriomas recurrence rates after sclerotherapy and procedural complications were also analyzed.
A total of 96 cycles (67 patients) were included: 46 cycles (34 patients) in the ethanol sclerotherapy group and 50 cycles (33 patients) in the control group. After propensity score weighting, the pregnancy and live-birth rates were significantly higher in the ethanol sclerotherapy group compared to the control group (weighted OR, 2.9 ; 95 CI, 1.4 - 6.6 and weighted OR 2.4 ; 95 CI, 1.1 - 5.4 respectively), with a lower rate of pregnancy loss (weighted OR 0.3 ; 95 CI, 0.1 - 0.9). Ovarian response was similar in the two groups. The recurrence rate of endometrioma at 6 months after sclerotherapy was 20 %.
Sclerotherapy of endometrioma before ovarian stimulation may increase pregnancy rate, with a low rate of recurrence and a minimal risk of complication.
在体外受精/卵胞浆内单精子注射（IVF/ICSI）之前，乙醇硬化疗法对子宫内膜异位症囊肿的妊娠率有何影响？
我们回顾了接受 IVF/ICSI 周期治疗的大于 25mm 的子宫内膜异位症囊肿患者。所有有卵巢囊肿切除术病史的患者均被排除在外。我们比较了两组患者：一组是在卵巢刺激前经阴道行乙醇硬化治疗子宫内膜异位症囊肿的患者，另一组是在 IVF/ICSI 时保留子宫内膜异位症囊肿（未治疗）的患者（对照组）。通过逆概率治疗加权法对混杂因素进行分析调整。主要终点是每个 IVF/ICSI 周期的进展妊娠率，包括新鲜和冷冻胚胎移植。次要终点是活产率、可成熟卵母细胞数、妊娠丢失率。还分析了硬化治疗后子宫内膜异位症囊肿的复发率和手术并发症。
共纳入 96 个周期（67 例患者）：乙醇硬化治疗组 46 个周期（34 例），对照组 50 个周期（33 例）。在倾向评分加权后，与对照组相比，乙醇硬化治疗组的妊娠和活产率显著更高（加权 OR，2.9；95%CI，1.4-6.6 和加权 OR 2.4；95%CI，1.1-5.4），妊娠丢失率较低（加权 OR 0.3；95%CI，0.1-0.9）。两组的卵巢反应相似。硬化治疗后 6 个月，子宫内膜异位症囊肿的复发率为 20%。
在卵巢刺激前进行子宫内膜异位症囊肿硬化治疗可能会提高妊娠率，复发率低，并发症风险小。
