The effect of endometriosis on live birth rate and other reproductive outcomes in ART cycles: a cohort study
The effect of endometriosis on live birth rate and other reproductive outcomes in ART cycles: a cohort study
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DOI：
10.1093/hropen/hoy016
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发表时间：
2018-01-01
影响因子：
8.3
通讯作者：
Becker, Christian M.
中科院分区：
文献类型：
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作者：
Muteshi, Charles M.;Ohuma, Eric O.;Becker, Christian M.
研究问题：子宫内膜异位症与不明原因的不孕症相比，对接受IVF和胚胎移植（ET）的妇女的活产率有什么影响？简要答复：子宫内膜异位症会降低接受IVF-ET治疗的女性的活产率，特别是随着疾病严重程度的增加。已知情况：子宫内膜异位症影响多达50%寻求生育治疗的女性，并且已知会降低生育能力。关于子宫内膜异位症对IVF治疗结果的影响仍有争议，活产是次要结果或在大多数研究中未报道。研究设计，规模，持续时间：回顾性队列研究，分析2000年1月至2014年12月IVF治疗周期的数据。在三级生育治疗中心接受第一周期IVF-ET的子宫内膜异位症妇女（n = 531）和不明原因的生育力低下妇女（n = 737）被纳入研究。主要结局为活产。其他结局指标包括对卵巢刺激的反应、胚胎发育和种植率。进行双变量和多变量逻辑回归分析，并使用卡方检验或Student t检验进行差异比较。主要结果和机会的作用：子宫内膜异位症妇女与不明原因的不孕症妇女相比，活产的可能性降低24%[比值比（OR）0.76（95%CI，0.59-0.98）P = 0.035]。随着子宫内膜异位症严重程度的增加，这种影响变得更加明显。使用多变量logistic回归分析，活产率较低的趋势仍然存在，但未达到统计学显著性[校正OR 0.76（95%CI 0.56-1.03），P = 0.078]。当移植两个胚胎而不是一个ET时，子宫内膜异位症妇女与不明原因的低生育力妇女一样可能有单胎活产[OR 1.38（95%CI 0.73-2.62），P = 0.32和OR 3.22（95%CI 1.7-6.05），P = 0.0003]。与原因不明的生育力低下的妇女相比，子宫内膜异位症的妇女获得的卵母细胞较少。（10.54（95% CI 10.13-0.95）和9.15（95%CI 8.69-9.6）]，囊胚移植率较低[OR 0.24（95%CI 0.12-0.5），P = 0.0001]和显著降低的种植率[OR 0.73（0.58-0.92），P = 0.007]。限制因素预防原因：本研究受回顾性设计的限制。通过限制研究到一个单一的ET周期，它是不可能的，以评估累积的结果，包括使用所有的冷冻胚胎。更广泛的影响的发现：子宫内膜异位症有相似的表型之间的妇女在不同的人群，并预计将有类似的影响生育能力。因此，这些结果可推广到其他妇女群体。
STUDY QUESTION: What is the effect of endometriosis compared to unexplained subfertility on live birth rate in women undergoing IVF and embryo transfer (ET)?SUMMARY ANSWER: Endometriosis decreases live birth rate in women undergoing IVF-ET treatment, particularly with increasing severity of the disease.WHAT IS KNOWN ALREADY: Endometriosis affects up to 50% of women seeking fertility treatment and is known to reduce fecundity. There remains a debate as to effects of endometriosis on the outcomes of IVF treatment, with live birth being a secondary outcome or not reported in most studies.STUDY DESIGN, SIZE, DURATION: A retrospective cohort study analyzing data of IVF treatment cycles from January 2000 to December 2014 was carried out.PARTICIPANTS/MATERIALS, SETTING, METHODS: Women with endometriosis (n = 531) and women with unexplained subfertility (n = 737) undergoing a first cycle of IVF-ET in a tertiary fertility treatment center were included in the study. The primary outcome was live birth. Other outcome measures were response to ovarian stimulation, embryo development and implantation rate. Bivariate and multivariate logistic regression analysis was performed and differences compared using Chi squared test of Student's t-test as appropriate.MAIN RESULTS AND THE ROLE OF CHANCE: Women with endometriosis had 24% less likelihood of a live birth when compared to those with unexplained subfertility [odds ratio (OR) 0.76 (95% CI, 0.59-0.98) P = 0.035]. This effect became more apparent with increasing severity of endometriosis. Using multivariable logistic regression analysis, the trend for lower live birth rate remained but did not reach statistical significance [adjusted OR 0.76 (95% CI 0.56-1.03), P = 0.078]. Women with endometriosis were as likely as those with unexplained subfertility to have a singleton live birth when two embryos were transferred as opposed to a single ET [OR 1.38 (95% CI 0.73-2.62), P = 0.32 and OR 3.22 (95% CI 1.7-6.05), P = 0.0003, respectively]. Compared to women with unexplained subfertility, those with endometriosis had fewer oocytes retrieved [(10.54 (95% CI 10.13-0.95) and 9.15 (95% CI 8.69-9.6), respectively], lower blastocyst transfer [OR 0.24 (95% CI 0.12-0.5), P = 0.0001] and a significantly reduced implantation rate [OR 0.73 (0.58-0.92), P = 0.007].LIMITATIONS REASONS FOR CAUTION: The study is limited by a retrospective design. By limiting the study to a single ET cycle, it was not possible to assess the cumulative outcome including use of all frozen embryos.WIDER IMPLICATIONS OF THE FINDINGS: Endometriosis has similar phenotypes among women in different populations and would be expected to have a similar effect on fertility. These results are therefore generalizable to other populations of women.