手术治疗卵巢子宫内膜异位囊肿对IVF的影响

Effect of surgical treatment for ovarian endometrioma on in vitro fertilization outcomes

目的探讨手术治疗卵巢子宫内膜异位囊肿对接受体外受精(IVF)助孕治疗的临床妊娠率及卵巢对促性腺激素刺激反应力的影响。方法回顾性分析2008年1月至2011年5月在该生殖中心接受IVF助孕治疗的295例患有卵巢子宫内膜异位症不孕患者的临床资料,其中有180例在IVF助孕治疗前进行了手术(其中75例为开腹组,180例为腹腔镜组);另115例未进行手术。观察并比较两组患者的临床妊娠率和卵巢对促性腺激素(Gn)刺激的反应力(Gn使用天数、Gn总用量、平均获卵数以及优质胚胎率);同时比较开腹组与腹腔镜组之间的临床妊娠率和卵巢对促性腺激素刺激的反应力。结果手术治疗组和未手术治疗组之间的Gn使用天数、Gn总用量、平均获卵数、优质胚胎率、种植率及平均移植胚胎数差异无统计学意义(P=0.610,P=0.569,P=0.343,P=0.690);与IVF助孕治疗前未接受手术治疗的卵巢子宫内膜异位患者组相比,接受了手术治疗的患者组其临床妊娠率有所提高(P<0.01);而开腹组与腹腔镜组之间的Gn使用天数、Gn总用量、平均获卵数、优质胚胎率、平均移植胚胎数、种植率及临床妊娠率比较,差异无统计学意义。与IVF助孕治疗前未接受手术治疗的卵巢子宫内膜异位囊肿患者相比,接受了手术治疗的卵巢子宫内膜异位囊肿患者临床妊娠率有明显的提高;而手术治疗卵巢子宫内膜异位囊肿患者其卵巢对Gn刺激的反应力没有显著性影响。结论手术治疗卵巢子宫内膜异位囊肿对IVF助孕治疗具有一定临床应用前景。

Objective To investigate the effect of surgical treatment of ovarian endometrioma on pregnancy rate and ovarian response to gonadotrophin stimulation in women undergoing in vitro fertilization （IVF）. Methods The clinical data in 295 infertility women with ovarian endometrioma undergoing IVF in our center from January 2010 to May 2011 were performed the retrospectivel analysis. Among them,180 cases received surgery befor IVF,including 75 cases of open operation and 180 cases of laparoscopy. Other 115 cases were without surgery. The clinical pregnancy rate, ovarian response to gonadotrophins（days of gonadotrophin am poules,number of gonadotrophin ampoules, number of oocytes retrieved, and number of good quality embryos）were observed and compared between two groups. At the same time, the clinical pregnancy rate and ovarian response to gonadotrophins were observed and compared between the open operation group and the laparoscopic group. Results There were no statistical differences in the number of gonadotrophin ampoules,days of gonadotrophin ampoules, number of oocytes retrieved, number of good quality embryos, implantation rate and number of embryos available for transfer between the operation group and the non operation group （P = 0. 610 ; P = 0. 569 ; P = 0. 343 ; P = 0. 690）. Compared with the ovarian endometrioma patients without surgery before IVF, the clinical pregnancy rate in the ovarian endometrioma patients undergone surgery was increased, but the ovarian response to gonadotrophin han no significant influence（P〈0.01）. There was no statistical differences in Gn days, total dose of Gn, number of oocytes re trieved, number of good quality embryos, average embryo transfer number,implantation rate and clinical pregnancy rate between the open operation group and the laparoscopic group. Conclusion surgical treatment of ovarian endometrioma has certain application prospect for IVF treatment..