The impact of endometriosis on the outcome of Assisted Reproductive Technology.
The impact of endometriosis on the outcome of Assisted Reproductive Technology.
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子宫内膜异位症对辅助生殖技术结果的影响。
DOI：
10.1186/s12958-016-0217-2
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发表时间：
2017-01-24
期刊：
影响因子：
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通讯作者：
Checa MÁ
中科院分区：
文献类型：
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作者：
González-Comadran M;Schwarze JE;Zegers-Hochschild F;Souza MD;Carreras R;Checa MÁ
子宫内膜异位症已被描述为通过各种机制损害生育能力。然而，评估接受辅助生殖技术的妇女的生殖结果的研究显示了有争议的结果。本研究的目的是评估在接受IVF的子宫内膜异位症相关不孕症妇女中，生殖结果是否受损。进行了一项回顾性队列研究，包括2010年1月至2012年12月期间Red Latinoamericana de Reproduccion Asistida（Redlara）登记处报告的接受IVF的女性。研究组包括输卵管疾病相关不孕妇女，对照组包括输卵管因素、内分泌紊乱或不明原因不孕妇女。排除40岁以上女性、严重男性因素及卵巢早衰。比较两组的生育结局。主要结局为活产。次要结局包括临床妊娠、流产、获卵数和受精卵数。在第一个新鲜IVF周期后评估结果，并根据年龄和移植的胚胎数量进行调整。共纳入22.416名妇女（3.583名子宫内膜异位症患者和18.833名对照组）。子宫内膜异位症组和对照组患者的平均年龄分别为34.86（3.47）和34.61（3.91），p = 0.000。平均获卵数分别为8.89（6.23）和9.86（7.02），p = 0.000。两组在活产（比值比（OR）1.032，p = 0.556）、临床妊娠（OR 1.044，p = 0.428）和流产率（OR 1.049，p = 0.623）方面没有观察到显著差异。子宫内膜异位症女性的获卵数显著较低（发病风险比（IRR）0.917，95% CI 0.895-0.940），然而，当调整获卵数时，两组的受精卵数无差异（IRR 1.003，p = 0.794）。进行了年龄分层分析，对于35岁以下和35至40岁的女性，各组之间的生殖结果没有观察到差异。接受IVF并被诊断患有子宫内膜异位症相关不孕症的妇女的生殖结果与未患此病的妇女没有显著差异。虽然患有子宫内膜异位症的女性产生的卵母细胞较少，但受精率不受影响，实现活产的可能性也不受影响。
Endometriosis has been described to impair fertility through various mechanisms. However, studies evaluating the reproductive outcomes of women undergoing assisted reproductive technologies show controversial results. The aim of this study is to assess whether the reproductive outcome is impaired among women with endometriosis-associated infertility undergoing IVF. A retrospective cohort study was performed, including women undergoing IVF reported by the Red Latinoamericana de Reproduccion Asistida (Redlara) registry, between January 2010 and December 2012. The study group included women with endometriosis-associated infertility, and the control group women with tubal factor, endocrine disorders or unexplained infertility. Women above 40 years, severe male factor and premature ovarian failure were excluded. The reproductive outcomes of between both groups were compared. The primary outcome was live birth. Secondary outcomes included clinical pregnancy, miscarriage, number of oocytes retrieved and number of fertilized oocytes. Outcomes were assessed after the first fresh IVF cycle, and were adjusted for age and number of embryos transferred. A total of 22.416 women were included (3.583 with endometriosis and 18.833 in the control group). Mean age of patients in the endometriosis group and control group was 34.86 (3.47) and 34.61 (3.91) respectively, p = 0.000. The mean number of oocytes retrieved were 8.89 (6.23) and 9.86 (7.02) respectively, p = 0.000. No significant differences were observed between groups in terms of live birth (odds ratio (OR) 1.032, p = 0.556), clinical pregnancy (OR 1.044, p = 0.428) and miscarriage rates (OR 1.049, p = 0.623). Women with endometriosis had significantly lower number of oocytes retrieved (incidence risk ratio (IRR) 0.917, 95% CI 0.895–0.940), however, the number of fertilized oocytes did not differ among the two groups when adjusting for the number of oocytes retrieved (IRR 1.003, p = 0.794). An age-stratified analysis was performed, and no differences were observed in the reproductive outcomes between groups for women aged under 35 and 35 to 40. Reproductive outcomes among women undergoing IVF and diagnosed with endometriosis-associated infertility do not differ significantly from women without the disease. Although women with endometriosis generate fewer oocytes, fertilization rate is not impaired and the likelihood of achieving a live birth is also not affected.