Kim C H, Chae H D, Kang B M, Chang Y S, Mok J E
Department of Obstetrics and Gynecology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea.
J Obstet Gynaecol Res. 1997 Oct;23(5):463-70. doi: 10.1111/j.1447-0756.1997.tb00874.x.
To investigate if the immunotherapy with corticosteroids would improve the pregnancy rate in infertile patients with endometriosis who undergo in vitro fertilization and embryo transfer (IVF-ET).
Forty-two infertile patients with endometriosis plus tubal factor and 87 pure tubal infertility patients who underwent IVF-ET in our unit were allocated randomly to the corticosteroid treatment group and the control group.
The prevalence of autoantibodies (antinuclear antibody, lupus anticoagulant, anticardiolipin antibody, rheumatoid factor) was elevated significantly in patients with endometriosis plus tubal factor compared with pure tubal infertility patients (38.1% vs 2.3%). Twenty-one patients with endometriosis plus tubal factor underwent 54 cycles of IVF-ET, receiving corticosteroids. Forty-three patients with pure tubal factor underwent 81 cycles of IVF-ET, receiving corticosteroids. Twenty-one patients with endometriosis plus tubal factor who underwent 57 cycles of IVF-ET and 44 patients with pure tubal factor who underwent 84 cycles of IVF-ET served as controls, not receiving corticosteroids. In patients with endometriosis plus tubal factor, there was a significantly higher clinical pregnancy rate per cycle in the treatment group, with 42.6% (23/54) compared with 22.8% (13/57) in the control group but no differences between 2 groups in spontaneous abortion rate (21.7% vs 15.4%) and multiple pregnancy rate (17.4% vs 15.4%). In patients with pure tubal infertility, there were no significant differences between the treatment group and control group in clinical pregnancy rate (40.7% vs 34.5%), spontaneous abortion rate (12.1% vs 10.3%) or multiple pregnancy rate (18.2% vs 10.3%). In the endometriosis plus tubal infertility group with autoantibodies, the clinical pregnancy rate per cycle was significantly higher in the treatment group at 40.9% compared with 14.8% in the control group. In endometriosis plus tubal infertility group without autoantibodies, there was no significant difference between 2 groups with respect to the clinical pregnancy rate per cycle (43.8% vs 30.0%).
This study suggests that immunotherapy with corticosteroids could improve the clinical pregnancy rate in endometriosis patients undergoing IVF-ET and may be more effective in patients with positive autoantibodies.
探讨皮质类固醇免疫疗法是否能提高接受体外受精-胚胎移植（IVF-ET）的子宫内膜异位症不孕患者的妊娠率。
将我院42例合并输卵管因素的子宫内膜异位症不孕患者和87例单纯输卵管性不孕且接受IVF-ET的患者随机分为皮质类固醇治疗组和对照组。
合并输卵管因素的子宫内膜异位症患者自身抗体（抗核抗体、狼疮抗凝物、抗心磷脂抗体、类风湿因子）的发生率显著高于单纯输卵管性不孕患者（38.1% 对2.3%）。21例合并输卵管因素的子宫内膜异位症患者接受皮质类固醇治疗，进行了54个周期的IVF-ET。43例单纯输卵管因素患者接受皮质类固醇治疗，进行了81个周期的IVF-ET。21例合并输卵管因素的子宫内膜异位症患者进行了57个周期的IVF-ET，44例单纯输卵管因素患者进行了84个周期的IVF-ET作为对照，未接受皮质类固醇治疗。在合并输卵管因素的子宫内膜异位症患者中，治疗组每周期的临床妊娠率显著更高，为42.6%（23/54），而对照组为22.8%（13/57），但两组间自然流产率（21.7% 对15.4%）和多胎妊娠率（17.4% 对15.4%）无差异。在单纯输卵管性不孕患者中，治疗组与对照组在临床妊娠率（40.7% 对34.5%）、自然流产率（12.1% 对10.3%）或多胎妊娠率（18.2% 对10.3%）方面无显著差异。在合并输卵管因素且有自身抗体的子宫内膜异位症不孕组中，治疗组每周期的临床妊娠率显著更高，为40.9%，而对照组为14.8%。在合并输卵管因素且无自身抗体的子宫内膜异位症不孕组中，两组间每周期的临床妊娠率无显著差异（43.8% 对30.0%）。
本研究表明，皮质类固醇免疫疗法可提高接受IVF-ET的子宫内膜异位症患者的临床妊娠率，且对自身抗体阳性患者可能更有效。
