卵巢囊肿手术对卵巢储备及体外受精-胚胎移植妊娠结局的影响

Effects of cystectomy for ovary benign cyst on ovarian reserve and pregnancy outcome of in vitro fertilization-embryo transfer cycle

目的探讨卵巢囊肿剥除手术对卵巢储备及对体外受精-胚胎移植妊娠结局的影响。方法回顾性分析2013年1月至2014年6月于山东大学附属生殖医院行体外受精或卵母细胞胞质内单精子注射法．胚胎移植（IVF／ICSI-ET）的622例不孕症患者的临床资料，手术组为卵巢囊肿手术后患者153例，包括44例卵巢子宫内膜异位囊肿、35例成熟畸胎瘤、67例单纯卵巢囊肿及7例卵巢黏液性囊腺瘤；同期以年龄匹配、因输卵管因素或男方因素行IVF／ICSI—ET治疗、无卵巢手术史的469例患者为对照组，比较两组患者的卵巢储备指标及IVF／ICSI-ET妊娠结局。并进一步分析不同类型卵巢囊肿对卵巢储备及IVF／ICSI-ET结局的影响，以卵巢子宫内膜异位囊肿术后者为异位囊肿组（44例），以成熟畸胎瘤、单纯卵巢囊肿及卵巢黏液性囊腺瘤术后者为其他囊肿组（109例）。结果（1）与对照组患者相比，手术组患者血清抗苗勒管激素（AMH）水平（M分别为：2．90、1．92mg／L）、窦卵泡数（AFC；M分别为：13．0、12．0个）、获卵数[分别为（13±6）、（12±5）个]、冷冻胚胎数（M分别为：3．0、1．0个）减少，分别比较，差异均有统计学意义（P〈0．05）。两组FSH、促性腺激素（Gn）用药天数及Gn用药总量比较无差异（P〉0．05）。手术组患者的临床妊娠率（61．4％，81／132）低于对照组（61．6％，241／391），但两组比较，差异无统计学意义（P=0．96）。（2）异位囊肿组患者的AFC、AMH、获卵数及冷冻胚胎数减少且明显低于其他囊肿组[分别为：（11±4）、（13±5）个；1．65、2．15mg／L；（9＋4）、（13＋5）个；0、2．0个]，分别比较，差异均有统计学意义（P〈0．01）。与其他囊肿组相比，异位囊肿组患者的临床妊娠率降低[分别为66．0％（62／94）、50．0％（19／38）]、流产率增高[分别为9．7％（6／62）、3／19]，但两组比较，差异均无统计学意义（P〉0．05）。结论卵巢囊肿剥除手术后卵巢储备下降，获卵数、冷冻胚胎数减少，但对临床妊娠率无明显影响；卵巢子宫内膜异位囊肿手术相对于其他卵巢囊肿的手术，对卵巢储备的损伤更严重。

Objective To investigate the impact of previous cystectomy for ovary benign cyst on ovarian reserve and pregnancy outcome in in vitro fertilization/intracytoplasmic sperm injection-embryo transfer （IVF/ICSI-ET） cycles. Methods Totally 622 infertility patients were retrospectively investigated who underwent first IVF/ICSI-ET cycle in Reproductive Hospital Affiliated to Shandong University from January 2013 to June 2014. There were 153 cases who had been removed ovarian cyst by cysteetomy surgeries recruited as study group, in which 44 cases of ovarian endometriosis cyst, 35 cases of benign ovarian teratomas, 67 cases of simple ovarian cyst and 7 cases of ovarian mucinous eystadenoma. In contrast, 469 infertility patients with tubal-factor infertility or male factor were included as control group. The age-matched women in the control group had no ovarian surgery previously. The indicators of ovarian reserve and pregnancy outcome were analyzed between two groups. The influence of different types of ovarian cysts on ovarian reserve and pregnancy outcome in IVF/ICSI-ET cycles were also studied, ovarian endometriosis cyst was studied as Group A, and Group B consisted of benign ovarian teratomas, simple ovarian cyst and mucinous cystadenoma. Results （1） The significantly lower serum antimullerian hormone （AMH） level （median： 1.92 versus 2.90 mg/L）, antral follicle count （AFC; median： 12.0 versus 13.0）, retrieved oocytes （12_＋5 versus 13_＋6） and the number of embryo cryopreserved （median： 1.0 versus 3.0） were found in study group compared with control group （all P〈0.05）. There was no statistical difference between two group for the following parameters, such as basal FSH level, the total dosage of gonadotropin duration and the total dosage of gonadotropin （all P〉0.05）. A better clinical pregnancy rate was achieved in control group （61.6%, 241/391） than that in study group （61.4%, 81/132）, but no significant difference was existed （P=0.96）. （2） Compared to Group B, Group A had fewer AFC, lower serum AMH level, retrieved oocytes and the number of embryo cryopreserved （11_＋4 versus 13_＋5; 1.65 versus 2.15 rag/L; 9_＋4 versus 13_＋5; 0 versus 2.0; all P〈 0.01）. There was a lower clinical pregnancy rate in Group A than that in Group B [50.0% （19/38） versus 66.0% （62/94）], accompanying with higher abortion rate [3/19 versus 9.7% （6/62）], but no differences were observed （all P〉0.05）. Conclusions Ovarian reserve declines after the cystectomy for ovarian benign cysts and the cystectomy has a negative impact on IVF/ICSI-ET cycle, resulting in a decrease of the number of retrieved oocytes and the number of embryo cryopreserved, but do not influence clinical pregnancy outcome. Ovarian reserve is impaired more seriously by cystectomy for ovarian endometriosis cyst than other ovarian benign cyst.