盆腔手术及年龄对子宫内膜异位症患者辅助生殖妊娠结局的影响

摘要

目的 分析盆腔手术及不同年龄对子宫内膜异位症(EMs)患者体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)妊娠结局的影响.方法 回顾性分析2015年5月1 5日至2017年2月28日在广州医科大学附属第三医院生殖医学中心接受IVF/ICSI-ET治疗的1 528例EMs患者(共2 659个周期).根据促排卵前是否进行过盆腔手术分为盆腔手术史组(1123例)和无盆腔手术史组(405例),再按照不同年龄将手术史组和无手术史组分为≤35岁组和＞35岁组,比较各组患者的性激素水平及妊娠结局.结果 手术史组和无手术史组EMs患者的血清基础E2、LH水平比较无显著性差异(P＞0.05);手术史组的基础FSH值显著高于无手术史组[(6.77±5.26)U/L vs.(6.04±2.47) U/L],基础窦卵泡计数(AFC)显著低于无手术史组[(12.38±6.61)个vs.(12.98±6.53)个](P均＜0.05).手术史组的总临床妊娠率显著低于无手术史组(16.90％ vs.20.32％)(P＜0.05).不同年龄亚组中,手术史组中≤35岁患者的基础FSH值显著低于＞35岁患者,E2值、AFC及总临床妊娠率则显著高于＞35岁患者(P均＜0.05);无手术史组中≤35岁患者的基础FSH值显著低于＞35岁患者,AFC及总临床妊娠率显著高于＞35岁患者(P均＜0.05).结论 对需行IVF/ICSI-ET助孕治疗的EMs患者,应尽早生育(最好≤35岁),且应尽量避免盆腔手术,如必须手术治疗,建议先取卵后手术.%Objective:To analyze influence of pelvic surgery and age on the pregnancy outcome of IVF/ICSI-ET in the patients with endometriosis(EMs).Methods:The data of 1 528 patients(a total of 2 659 cycles)with endometriosis in IVF/ICSI-ET treatment in the reproductive medicine center of the Third Affiliated Hospital of Guangzhou Medical University from May 15,2015 to February 28,2017 was took into retrospective analysis.Firstly,the EMs patients were divided into the group with pelvic surgery(n=1 123)and the group without pelvic surgery (n=405)according to whether there was a history of pelvic surgery before induced ovulation.And then,the EMs patients in pelvic surgery group and no pelvic surgery group were subdivided to ≤35 and ＞35 years old group respectively.The sex hormone levels and the clinical pregnancy outcome were compared among the groups.Results:Both of basic E2 and LH levels were not significantly different between pelvic surgery group and no pelvic surgery group.The basicFSH levels[(6.77+5.26)vs.(6.04+2.47)U/L] of patients in pelvic surgery group was significantly higher than those in the no pelvic surgery group(P＜0.05).The number of AFC [(12.38 + 6.61) vs.(12.98+ 6.53)] and the total clinical pregnancy rate (16.90％ vs.20.32％)in pelvic surgery group were significantly lower than those in no pelvic surgery group(P＜0.05).The basic FSH level was significantly lower,the E2,AFC and total clinical pregnancy rate was significantly higher in ≤35 years group than ＞35 years group in pelvic surgery group(all P＜ 0.05).Similarly,the basic FSH level was significantly lower,the AFC and total clinical pregnancy rate were significantly higher in ≤35 years group than ＞35 years group in no pelvic surgery group(all P＜ 0.05).Conclusions:IVF/ICSI-ET treatment for the patients with EMs undergoing should be as soon as possible(preferably ≤35 years of age),and pelvic surgery should be avoided as far as possible.If pelvic surgery is necessary,it is recommended that the surgery is performed after oocyte retrieved.