Mappa Ilenia, Page Zoe Pauline, Di Mascio Daniele, Patelli Chiara, D'Antonio Francesco, Giancotti Antonella, Gebbia Francesco, Mariani Giulia, Cozzolino Mauro, Muzii Ludovico, Rizzo Giuseppe
Department of Obstetrics and Gynecology, Fondazione Policlinico di Tor Vergata, University of Rome Tor Vergata, 00133 Roma, Italy.
Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, 00185 Roma, Italy.
Healthcare (Basel). 2024 Dec 3;12(23):2435. doi: 10.3390/healthcare12232435.
The purpose of this study was to evaluate the impact of endometriosis on various outcomes of in vitro fertilization (IVF), including live birth rates, clinical pregnancy rates, fertilization rates, and implantation rates, through a systematic review and meta-analysis.
Systematic searches were carried out using PubMed, MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, EMBASE, and Web of Science from January 2010 to November 2023. Studies comparing IVF outcomes in women with and without endometriosis were included. The primary outcome was live birth rate; secondary outcomes included clinical pregnancy, fertilization, and implantation rates. Data were extracted and analyzed using odds ratio (OR) and 95% confidence interval (CI) with fixed or random-effects models, depending on heterogeneity.
From 1340 studies initially identified, 40 studies met the inclusion criteria, encompassing 8970 women with endometriosis and 42,946 control participants. There were no significant differences between the endometriosis and control groups in terms of live birth rate (OR 1.03, 95% CI 0.75-1.41, = 0.84), clinical pregnancy rate (OR 0.86, 95% CI 0.72-1.02, = 0.1), or fertilization rate (OR 0.96, 95% CI 0.79-1.15, = 0.64). However, endometriosis was associated with a significantly lower implantation rate (OR 0.85, 95% CI 0.74-0.97, = 0.02).
Endometriosis significantly negatively affects implantation rates in women undergoing IVF, despite the absence of significant differences in live birth, clinical pregnancy, and fertilization rates. Further research is needed to evaluate the impact of different stages of endometriosis on IVF outcomes and to develop optimized management protocols for these patients.
本研究旨在通过系统评价和荟萃分析，评估子宫内膜异位症对体外受精（IVF）各种结局的影响，包括活产率、临床妊娠率、受精率和着床率。
于2010年1月至2023年11月期间，使用PubMed、MEDLINE、Cochrane对照试验中央注册库、Scopus、EMBASE和Web of Science进行系统检索。纳入比较有和没有子宫内膜异位症的女性IVF结局的研究。主要结局是活产率；次要结局包括临床妊娠、受精和着床率。根据异质性，使用比值比（OR）和95%置信区间（CI），采用固定效应或随机效应模型提取和分析数据。
在最初识别的1340项研究中，40项研究符合纳入标准，包括8970例患有子宫内膜异位症的女性和42946例对照参与者。子宫内膜异位症组和对照组在活产率（OR 1.03，95%CI 0.75 - 1.41，I² = 0.84）、临床妊娠率（OR 0.86，95%CI 0.72 - 1.02，I² = 0.1）或受精率（OR 0.96，95%CI 0.79 - 1.15，I² = 0.64）方面没有显著差异。然而，子宫内膜异位症与显著较低的着床率相关（OR 0.85，95%CI 0.74 - 0.97，I² = 0.02）。
尽管在活产、临床妊娠和受精率方面没有显著差异，但子宫内膜异位症对接受IVF的女性的着床率有显著负面影响。需要进一步研究以评估子宫内膜异位症不同阶段对IVF结局的影响，并为这些患者制定优化的管理方案。
