Pal L, Shifren J L, Isaacson K B, Chang Y, Leykin L, Toth T L
Department of Reproductive Endocrinology, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
J Assist Reprod Genet. 1998 Jan;15(1):27-31. doi: 10.1023/a:1022574221115.
The impact of severity of endometriosis on the outcome of in vitro fertilization (IVF) was analyzed in an uncontrolled, retrospective study in an academic IVF program.
Sixty-one patients with a primary diagnosis of endometriosis undergoing 85 cycles of IVF were included in the study. Patients were divided according to the severity of disease based on the revised American Fertility Society (AFS) classification into groups A (stages I/II, or minimal/ mild) and B (stages III/IV, or moderate/severe). Group A included 32 patients undergoing 45 IVF-embryo transfer (ET) cycles; group B included 29 patients undergoing 40 IVF cycles. Exclusion criteria were age older than 40 years, basal day 3 follicle stimulating hormone (FSH) greater than 20 IU/L, male-factor infertility, assisted hatching, and gamete intrafallopian transfer cases. Stimulation for IVF cycles was standard using pituitary down-regulation with gonadotropin-releasing hormone agonist in a midluteal protocol. Controlled ovarian hyperstimulation (COH) was achieved using a combination of FSH and human menopausal gonadotropin. Outcomes assessed included response to COH and number, maturity, and quality of oocytes retrieved. Fertilization, implantation, and pregnancy rates after IVF-ET were also analyzed.
The response to COH and the number, maturity, and quality of the oocytes was comparable between patients with varying severity of endometriosis. Fertilization rates for oocytes of patients in group B (stages III/IV) were significantly impaired compared to those in group A (stages I/II) (P = 0.004). The rates for implantation, clinical pregnancy, and miscarriage were comparable between the two groups.
The reduced fertilization potential of the oocytes obtained from patients with severe endometriosis in the absence of male-factor infertility suggests an adverse biological impact of the advanced disease on the oocytes. The outcome of IVF-ET, however, is unaffected by increasing severity of endometriosis. This suggests that IVF may compensate for or overcome this reduction in the biological potential of the oocytes associated with severe disease, thus accounting for a comparable outcome irrespective of the severity of endometriosis.
在一项学术性体外受精（IVF）项目的非对照回顾性研究中，分析子宫内膜异位症的严重程度对体外受精结局的影响。
本研究纳入了61例初步诊断为子宫内膜异位症且接受85个IVF周期治疗的患者。根据修订后的美国生育协会（AFS）分类，将患者按疾病严重程度分为A组（I/II期，即轻微/轻度）和B组（III/IV期，即中度/重度）。A组包括32例患者，接受了45个IVF-胚胎移植（ET）周期；B组包括29例患者，接受了40个IVF周期。排除标准为年龄大于40岁、基础第3天卵泡刺激素（FSH）大于20 IU/L、男性因素不孕、辅助孵化以及配子输卵管内移植病例。IVF周期的刺激采用标准方案，在黄体中期使用促性腺激素释放激素激动剂进行垂体降调节。通过联合使用FSH和人绝经期促性腺激素实现控制性卵巢过度刺激（COH）。评估的结局包括对COH的反应以及获取的卵母细胞数量、成熟度和质量。还分析了IVF-ET后的受精、着床和妊娠率。
不同严重程度子宫内膜异位症患者对COH的反应以及卵母细胞数量、成熟度和质量相当。B组（III/IV期）患者卵母细胞的受精率与A组（I/II期）相比显著受损（P = 0.004）。两组间着床、临床妊娠和流产率相当。
在无男性因素不孕的情况下，重度子宫内膜异位症患者获取卵母细胞受精潜力降低，提示晚期疾病对卵母细胞有不良生物学影响。然而，IVF-ET的结局不受子宫内膜异位症严重程度增加的影响。这表明IVF可能补偿或克服与严重疾病相关的卵母细胞生物学潜力降低，从而无论子宫内膜异位症严重程度如何，结局相当。
