摘要
目的探索子宫内膜异位症(endometriosis,EMS)合并不孕患者的最佳治疗方案,以指导及帮助患者尽快获得临床妊娠。方法回顾性分析2015年1月至2019年12月我院EMS相关不孕患者的临床资料,评价手术对卵巢储备功能及体外受精(in vitro fertilization,IVF)助孕结局的影响,并比较不同卵巢刺激方案患者的一般情况、用药情况及治疗结局。结果与未手术组(A组)相比,手术治疗组(B组)窦卵泡数(antral follicle count,AFC)减少、基础卵泡刺激素(basal follicle-stimulating hormone,bFSH)水平升高、HCG日可取卵泡数减少、获卵数减少(P<0.05),两组间抗苗勒氏管激素(anti-mullerian hormone,AMH)、促性腺素(gonadotropin,Gn)时间、Gn总量、临床妊娠率、胚胎着床率、多胎率、流产率及异位妊娠率差异均无统计学意义(P>0.05)。卵泡期长效长方案中的B组与A组比较,胚胎着床率明显增高(P<0.05),其他亚组中B组与A组的胚胎着床率差异无统计学意义(P>0.05)。结论手术可能损伤卵巢储备功能,未经手术治疗直接采用IVF助孕者,多次GnRH-a有利于提高临床妊娠率;EMS术后通过GnRH-a单次降调后可提高临床妊娠率。
Objective To evaluate the optimal treatment for women with endometriosis-associatedinfertility.MethodsTotally 204 women with endometriosis-associated infertility in the past 5 years were includedin the retrospective study,to evaluate the effect of surgery on ovarian reserve and IVF assisted pregnancy outcomes.Compare general data,cycle characteristics and clinical outcome of patients with different ovarian stimulationprotocols.ResultsThe surgery treatment group(Group B)showed decrease of AFC,increase of b FSH level,decrease of follicular number greater than 14 mm on the day of HCG administration,and decrease of oocytesretrieved compared to the non-surgery treatment group(Group A)(P<0.05),while with no statistical significancesfor AMH,the dosages and duration of Gn,clinical pregnancy rates,implantation rates,multiple pregnancies rates,abortion rates and ectopic pregnancy rates(P>0.05).The implantation rate of the long protocol in Group B wassignificantly higher than that in Group A(P<0.05),while there were no statistical differences between Group A andGroup B in other subgroups(P>0.05).ConclusionsOvarian reserve was impaired by surgery.A multiple course ofGn RH-a prior to ovarian stimulation was beneficial to improve the clinical pregnancy rate for endometriosis patientswithout surgery before IVF/ICSI.While it would improve the clinical pregnancy rate by single use of prolonged Gn RH-a treatment for non-surgical group.
作者
陈曼
林虹
王玉莲
夏汝斌
李志凌
CHEN Man;LIN Hong;WANG Yulian;XIA Rubin;LI Zhiling(Reproductive Medicine Department,the First Affiliated Hospital of Shantou University Medical College,Shantou 515041,China)
出处
《实用医学杂志》
CAS
北大核心
2020年第17期2415-2419,共5页
The Journal of Practical Medicine
基金
2019年汕头市医疗卫生科技计划项目(编号:汕府科[2019]70号)。
