Diminished Ovarian Reserve and Endometriosis: Insult upon Injury
Diminished Ovarian Reserve and Endometriosis: Insult upon Injury
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DOI：
10.1055/s-0032-1333479
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发表时间：
2013-03-01
影响因子：
2.7
通讯作者：
Shah, Divya Kelath
中科院分区：
文献类型：
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作者：
Shah, Divya Kelath
子宫内膜异位症是一种影响相当大比例育龄妇女的疾病。该病对卵巢储备的影响是计划治疗时的一个重要考虑因素，当妇女想要保持她们未来生育的潜力。现有文献支持浅表性子宫内膜异位症和卵巢子宫内膜异位症对排卵率、卵巢储备标志物和卵巢刺激反应的不利影响，尽管临床妊娠和活产率的数据仍不一致。子宫内膜异位瘤的手术治疗可能会因无意中切除健康卵巢组织或损害卵巢血管供应而进一步恶化卵巢反应性。尽管证据总体上支持手术在提高自然妊娠率方面的作用，但在接受不孕症治疗的妇女亚组中，子宫内膜瘤的识别是否值得切除的问题仍然是一个持续争论的主题。许多医生建议直接进行体外受精，以减少怀孕时间，为出现较大子宫内膜异位瘤和伴随疼痛症状的妇女保留手术。需要进一步研究子宫内膜异位症损害卵巢的机制，以及对患有该疾病的不同妇女亚群的最适当治疗。
Endometriosis is a disease that affects a significant proportion of reproductive-age women. The impact of the disease on ovarian reserve is an important consideration when planning treatment in women who want to maintain their potential for future childbearing. The existing literature supports an adverse effect of both superficial endometriosis and ovarian endometriomas on ovulation rates, markers of ovarian reserve, and response to ovarian stimulation, although data on clinical pregnancy and live-birth rates remain inconsistent. Surgical treatment of endometriomas may further worsen ovarian responsiveness by inadvertently removing healthy ovarian tissue or compromising vascular supply to the ovary. Although the evidence overall supports a role for surgery in improving spontaneous pregnancy rates, the question of whether identification of an endometrioma warrants its excision in the subgroup of women undergoing infertility treatment remains a subject of ongoing debate. Many practitioners recommend proceeding directly to in vitro fertilization to reduce time to pregnancy, reserving surgery for women who present with large endometriomas and concomitant symptoms of pain. Further study is required as to the mechanisms by which endometriosis damages ovarian damage as well as the most appropriate treatment in various subpopulations of women with the disease.