子宫内膜异位症合并不孕症--手术还是助孕？

Endometriosis with Infertility,Surgery or Assisted Reproductive Technologies?

子宫内膜异位症(EMs)是妇科常见病,发病机制复杂,治疗困难,至少25%～35%的女性不孕症与EMs有关。EMs合并不孕的治疗一般不主张期待疗法,欧美及中国的最新EMs指南和共识也不建议采用药物治疗EMs以提高自然妊娠率,目前的主要治疗方式为手术治疗和助孕治疗,而采用何种方式及确切的实施时间等策略问题却存在争议。本文就微、轻度EMs合并不孕的手术及助孕治疗,中、重度EMs合并不孕的手术适应证及腹腔镜手术时机,手术治疗及对卵巢功能的影响,术后处理及术后妊娠率的评估,复发性EMs合并不孕的处理,疑似EMs合并不孕的处理,EMs合并不孕患者助孕前的药物预处理等问题进行探讨,并提出针对EMs合并不孕的处理建议。

Endometriosis is a common gynecologic disease with complex pathogenesis. It is very hard to treat. There are at least 25%-35% infertile female with endometriosis. Expectant treatment for infertility patient with endometriosis should not be recommend, and medication should also not be used for increasing the spontaneous pregnancy rate in many guidelines from Europe/USA/China. Surgery and assisted reproductive technologies （ARTs） are important treatment methods, but there are some debates in the strategy and opportune moment of treatment. In this review, we discussed some options on surgery and/or ART for infertility with minimal/mild endometriosis, surgery indication and opportunity in infertility with moderate/severe endometriosis, ovary protection during operation and effect of surgery on ovarian function, dispose after surgery and estimate of pregnancy rate, treatment for recurrent endometriosis with infertility, treatment for infertility with suspected endometriosis, pretreatment with GnRHa before ART in infertility with endometriosis. At last, we present our proposals on the treatment of endometriosis with infertility.