子宫内膜异位症相关不孕的治疗进展

Recent Advances in Treatment of Endometriosis-associated Infertility

子宫内膜异位症是引起育龄女性不孕的重要因素之一,引起不孕可能的原因有:患者腹腔液性质的改变、盆腔解剖结构异常、卵巢功能下降和子宫内膜容受性降低等。目前手术仍是主要的治疗方式,手术时机、手术方式、子宫内膜异位症手术分期及不同类型、程度子宫内膜异位症对术后妊娠结局均有影响,手术应尽可能在子宫内膜异位症早期进行,腹腔镜手术作为首选,子宫内膜异位症生育指数(EFI)评分能较好地评估患者的生育能力。而药物治疗作为术后辅助治疗,并不能提高患者的生育能力,只能延缓复发,因而对有生育要求的子宫内膜异位症合并不孕患者,手术后不推荐药物治疗。当手术治疗失败或因持续性输卵管因素导致不孕时,辅助生殖技术对于提高患者的生育能力是必要的。

Endometriosis is one of the important factors of female infertility. The possible causes of infertility include the change in peritoneal fluid, abnormal pelvic anatomy, the decreased ovarian function and the decreased endometrial receptivity. The surgery is still the main treatment of endometriosis. The pregnancy outcome after surgery is associated with the surgical time, operation method, stage and type of endometriosis. Surgery should be performed in the early stage of endometriosis as much as possible, and laparoscopic surgery is of the first choice. It is recommended that the endometriosis fertility index（EFI） score can be used to assess the fertility.Drug therapy as adjuvant therapy can not improve the patient′s fertility although it can delay recurrence. When the surgical treatment failed or there are persistent tubal factors leading to infertility, the assisted reproductive technology should be preferentially advised for those infertility women to improve timely their fertility.