卵巢子宫内膜异位囊肿对体外受精-胚胎移植结局的影响
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摘要
目的:探讨卵巢子宫内膜异位囊肿(Ovarian endometriosis cyst)对经体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)治疗的各个阶段及妊娠结局的影响。方法:选择行IVF-ET治疗的279例卵巢子宫内膜异位囊肿合并不孕患者的352个取卵周期作为研究组;选择同期行IVF-ET治疗的937例单纯输卵管因素不孕患者的1 059个取卵周期作为对照组,两组患者的年龄、体质量指数、不孕年限及促排方案相匹配。回顾性分析患者的临床基本资料及妊娠结局。结果:研究组取卵周期取消率显著高于对照组(P<0.05);研究组的基础窦卵泡数(AFC)、hCG注射日成熟卵泡数、获卵数、正常受精(2PN)数、卵裂数、可移植胚胎数、优质胚胎数、优质胚胎率均显著低于对照组(P<0.05);两组的正常受精率、卵裂率、种植率、生化妊娠率、临床妊娠率、早期流产率、晚期流产率及活产率比较,差异均无统计学意义(P>0.05)。结论:卵巢子宫内膜异位囊肿合并不孕患者卵巢储备功能下降,且影响卵子成熟及质量,但并不影响其正常受精及临床结局。
Objective: To investigate the effects of ovarian endometrioma on various stages of in vitro fertilization-embryo transfer(IVF-ET) and pregnancy outcomes.Method:The 352 oviposition cycles of 279 cases of ovarian endometrioma combined with infertility treated with IVF-ET were selected as the study group;1 059 oviposition cycles of 937 cases of tubal factors infertility treated with IVF-ET were selected. The egg cycle was used as a control group.The age,body mass index,infertility age,and propulsion plan were matched in both groups.Retrospective analysis of the patient's clinical data on pregnancy outcomes.Result:The removal rate of the oviductal cycle in the study group was significantly higher than that in the control group(P<0.05);the basic antral follicle number(AFC),the number of mature follicles at the h CG injection day, the number of oocytes retrieved, the number of normal fertilization(2PN),the number of cleavages, the number of transplantable embryos, the number of good embryos, and the rate of high-quality embryos in the study group were all significantly lower than those in the control group(P<0.05);normal fertilization rate,cleavage rate,implantation rate, biochemical pregnancy rate,clinical pregnancy rate,and early abortion between the two groups,there were no significant differences in rate,late abortion rate and live birth rate(P>0.05).Conclusion:Ovarian endometrioma with infertility patients with decreased ovarian reserve,and affect the egg maturity and quality,but does not affect the normal fertilization rate and clinical outcome.
Objective: To investigate the effects of ovarian endometrioma on various stages of in vitro fertilization-embryo transfer(IVF-ET) and pregnancy outcomes.Method:The 352 oviposition cycles of 279 cases of ovarian endometrioma combined with infertility treated with IVF-ET were selected as the study group;1 059 oviposition cycles of 937 cases of tubal factors infertility treated with IVF-ET were selected. The egg cycle was used as a control group.The age,body mass index,infertility age,and propulsion plan were matched in both groups.Retrospective analysis of the patient's clinical data on pregnancy outcomes.Result:The removal rate of the oviductal cycle in the study group was significantly higher than that in the control group(P<0.05);the basic antral follicle number(AFC),the number of mature follicles at the h CG injection day, the number of oocytes retrieved, the number of normal fertilization(2PN),the number of cleavages, the number of transplantable embryos, the number of good embryos, and the rate of high-quality embryos in the study group were all significantly lower than those in the control group(P<0.05);normal fertilization rate,cleavage rate,implantation rate, biochemical pregnancy rate,clinical pregnancy rate,and early abortion between the two groups,there were no significant differences in rate,late abortion rate and live birth rate(P>0.05).Conclusion:Ovarian endometrioma with infertility patients with decreased ovarian reserve,and affect the egg maturity and quality,but does not affect the normal fertilization rate and clinical outcome.
引文
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[4]王艳艳,冷金花,郎景和,等.腹腔镜下双侧卵巢子宫内膜异位囊肿剔除术后卵巢功能早衰2例报告及文献复习[J].中华妇产科杂志,2007,42(11):774-775.
[5]江楠,岳倩,段玉英,等.垂体后叶素水分离法在腹腔镜下卵巢子宫内膜异位囊肿剥除术中的应用及对卵巢功能的影响[J].现代妇产科进展,2013,22(7):581-583.
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[11]Gergolet M,Gianaroli L,Kenda Suster N,et al.Possible role of endometriosis in the aetiology of spontaneous miscarriage in patients with septate uterus[J].Reprod Biomed Online,2010,21(4):581-585.
[12]Benaglia L,Bermejo A,Somigliana E,et al.Pregnancy outcome in women with endometriomas achieving pregnancy through IVF[J].Hum Reprod,2012,27(6):1663-1667.
[13]Hansen M V H,Dalsgaard T,Hartwell D,et al.Reproductive prognosis in endometriosis.A national cohort study[J].Acta Obstetricia Et Gynecologica Scandinavica,2014,93(5):483-489.
[14]Mekaru K,Masamoto H,Sugiyama H,et al.Endometriosis and pregnancy outcome:are pregnancies complicated by endometriosis a high-risk group?[J].European Journal of Obstetrics Gynecology&Reproductive Biology,2014,172(1):36-39.
[15]Aris A A.12-year cohort study on adverse pregnancy outcomes in Eastern Townships of Canada:impact of endometriosis[J].Gynecol Endocrinol,2014,30(1):34-37.
[16]Barbosa M A,Teixeira D M,Navarro P A,et al.Impact of endometriosis and its staging on assisted reproduction outcome:systematic review and meta-analysis[J].Ultrasound Obstet Gynecol,2014,44(3):261-278.
[17]Hamdan M,Omar S Z,Dunselman G,et al.Influence of endometriosison assisted reproductive technology outcomes:a systematic review and meta-analysis[J].Obstet Gynecol,2015,125(2):79-88.
[18]Burney R O,Talbi S,Hamilton A E,et al.Gene expression analysis of endometrium reveals progesterone resistance and candidate susceptibility genes in women with endometriosis[J].Endocrinology,2007,148(8):3814-3826.
[19]Aguilar H N,Mitchell B F.Physiological pathways and molecular mechanisms regulating uterine contractility[J].Hum Reprod Update,2010,16(6):725-744.
[20]Somigliana E,Vigano P,Vignali M.Endometriosis and unexplained recurrent spontaneous abortion:pathological states resulting from aberrant modulation of natural killer cell function?[J].Hum Reprod Update,1999,5(1):40.
[21]Vignali M,Infantino M,Matrone R,et al.Endometriosis:novel etiopathogenetic concepts and clinical perspectives[J].Fertil Steril,2002,78(4):665-678.
[22]Burney R O,Giudice L C.Pathogenesis and pathophysiology of endometriosis[J].Fertil Steril,2012,98(3):511-519.
[23]Garcia-Velasco J A,Fassbender A,Ruiz-Alonso M,et al.Is endometrial receptivity transcriptomics affected in women with endometriosis?A pilot study[J].Reprod Biomed Online,2015,31(5):647-654.
[24]Leonardi M,Papaleo E,Reschini M,et al.Risk of miscarriage in women with endometriosis:insights from in vitro fertilization cycles[J].Fertil Steril,2016,106(2):386-392.
[2]郑婷萍,孙爱军,郎景和,等.北京协和医院住院患者不孕症与子宫内膜异位症30年变化趋势[J].中华妇产科杂志,2015,50(8):591-595.
[3]Missmer S A,Hankinson S E,Spiegelman D,et al.Incidence of laparoscopically confirmed endometriosis by demographic,anthropometric,and lifestyle factors[J].Am J Epidemiol,2004,160(8):784-796.
[4]王艳艳,冷金花,郎景和,等.腹腔镜下双侧卵巢子宫内膜异位囊肿剔除术后卵巢功能早衰2例报告及文献复习[J].中华妇产科杂志,2007,42(11):774-775.
[5]江楠,岳倩,段玉英,等.垂体后叶素水分离法在腹腔镜下卵巢子宫内膜异位囊肿剥除术中的应用及对卵巢功能的影响[J].现代妇产科进展,2013,22(7):581-583.
[6]Uncu G,Kasapoglu I,Ozerkan K,et al.Prospective assessment of the impact of endometriomas and their removal on ovarian reserve and determinants of the rate of decline in ovarian reserve[J].Human Reproduction,2013,28(8):2140-2145.
[7]Goud P T,Goud A P,Joshi N,et al.Dynamics of nitric oxide,altered follicular microenvironment,and oocyte quality in women with endometriosis[J].Fertil Steril,2014,102(1):151-159.
[8]Da Broi M G,Navarro P A.Oxidative stress and oocyte quality:ethiopathogenic mechanisms of minimal/mild endometriosis-relatedinfertility[J].Cell Tissue Res,2016,364(1):1-7.
[9]Xu B,Guo N,Zhang X M,et al.Oocyte quality is decreased in women with minimal or mild endometriosis[J].Scientific Reports,2015,5:10779.
[10]Hsu A L,Townsend P M,Oehninger S,et al.Endometriosis May beassociated with mitochondrial dysfunction in cumulus cells from subjects undergoing in vitro fertilization-intracytoplasmic sperminjection,as reflected by decreased adenosine triphosphateproduction[J].Fertil Steril,2015,103(2):347-352.
[11]Gergolet M,Gianaroli L,Kenda Suster N,et al.Possible role of endometriosis in the aetiology of spontaneous miscarriage in patients with septate uterus[J].Reprod Biomed Online,2010,21(4):581-585.
[12]Benaglia L,Bermejo A,Somigliana E,et al.Pregnancy outcome in women with endometriomas achieving pregnancy through IVF[J].Hum Reprod,2012,27(6):1663-1667.
[13]Hansen M V H,Dalsgaard T,Hartwell D,et al.Reproductive prognosis in endometriosis.A national cohort study[J].Acta Obstetricia Et Gynecologica Scandinavica,2014,93(5):483-489.
[14]Mekaru K,Masamoto H,Sugiyama H,et al.Endometriosis and pregnancy outcome:are pregnancies complicated by endometriosis a high-risk group?[J].European Journal of Obstetrics Gynecology&Reproductive Biology,2014,172(1):36-39.
[15]Aris A A.12-year cohort study on adverse pregnancy outcomes in Eastern Townships of Canada:impact of endometriosis[J].Gynecol Endocrinol,2014,30(1):34-37.
[16]Barbosa M A,Teixeira D M,Navarro P A,et al.Impact of endometriosis and its staging on assisted reproduction outcome:systematic review and meta-analysis[J].Ultrasound Obstet Gynecol,2014,44(3):261-278.
[17]Hamdan M,Omar S Z,Dunselman G,et al.Influence of endometriosison assisted reproductive technology outcomes:a systematic review and meta-analysis[J].Obstet Gynecol,2015,125(2):79-88.
[18]Burney R O,Talbi S,Hamilton A E,et al.Gene expression analysis of endometrium reveals progesterone resistance and candidate susceptibility genes in women with endometriosis[J].Endocrinology,2007,148(8):3814-3826.
[19]Aguilar H N,Mitchell B F.Physiological pathways and molecular mechanisms regulating uterine contractility[J].Hum Reprod Update,2010,16(6):725-744.
[20]Somigliana E,Vigano P,Vignali M.Endometriosis and unexplained recurrent spontaneous abortion:pathological states resulting from aberrant modulation of natural killer cell function?[J].Hum Reprod Update,1999,5(1):40.
[21]Vignali M,Infantino M,Matrone R,et al.Endometriosis:novel etiopathogenetic concepts and clinical perspectives[J].Fertil Steril,2002,78(4):665-678.
[22]Burney R O,Giudice L C.Pathogenesis and pathophysiology of endometriosis[J].Fertil Steril,2012,98(3):511-519.
[23]Garcia-Velasco J A,Fassbender A,Ruiz-Alonso M,et al.Is endometrial receptivity transcriptomics affected in women with endometriosis?A pilot study[J].Reprod Biomed Online,2015,31(5):647-654.
[24]Leonardi M,Papaleo E,Reschini M,et al.Risk of miscarriage in women with endometriosis:insights from in vitro fertilization cycles[J].Fertil Steril,2016,106(2):386-392.