卵巢子宫内膜异位囊肿剥除术对IVF周期中卵巢反应性和妊娠结局的影响  

Effects of Cystectomy for Ovarian Endometrioma on Ovarian Response and Outcome of in Vitro Fertilization and Embryo Transfer Cycle

作　　者：吴莉[1] 刘雨生[1] 何国平[1] 骆丽华[1] 童先宏[1] 栾红兵[1] 季静娟[1] 

机构地区：[1]安徽医科大学附属省立医院生殖中心,合肥230001

出　　处：《国际妇产科学杂志》2009年第2期154-157,共4页Journal of International Obstetrics and Gynecology

摘　　要：目的:探讨卵巢子宫内膜异位囊肿剥除术后对体外受精(IVF)周期控制性超排卵中卵巢反应性和妊娠结局的影响。方法:选取体外受精-胚胎移植(IVF-ET)助孕且曾在腹腔镜下行卵巢子宫内膜双侧异位囊肿剥除术20例(25周期)患者及32例单侧异位囊肿剥除术(40周期)患者为研究对象,以同期因输卵管因素行IVF助孕的104例(129周期)患者作为对照组,收集卵巢反应性及妊娠结局相关指标,作回顾性病例对照研究。结果:3组在年龄、体质量指数、不孕年限、基础卵泡刺激素(FSH)水平、促性腺激素(Gn)天数、受精率和人绒毛膜促性腺激素(hCG)日雌二醇(E2)水平无统计学意义(P>0.05)。3组妊娠率差异也无统计学意义(P>0.05),且单侧囊肿剥除组妊娠率最高(50.0%)。双侧囊肿剥除组获卵数、优质胚胎率及可冷冻的胚胎个数分别为[(4.95±3.46)个、(56.0±32.0)%、(1.40±1.96)个],明显低于单侧囊肿剥除组[(9.38±4.62)个、(70.1±20.2)%、(3.45±3.05)个]和输卵管组[(10.37±4.14)个、(85.1±19.9)%、(4.36±3.19)个],差异有统计学意义(P<0.01);其Gn总用量也明显高于输卵管组和单侧囊肿剥除组(P<0.05)。单侧异位囊肿剥除术的手术侧卵巢的获卵数[(3.34±2.92)个]低于未手术侧卵巢[(6.06±2.27)个](t=5.784,P<0.01)。结论:卵巢子宫内膜异位囊肿剥除术可影响IVF周期中卵巢反应性,如导致Gn用量增加,获卵数、优质胚胎数和可冷冻胚胎个数减少,对IVF-ET有一定不良影响,而对IVF妊娠结局无明显影响。Objective：To investigate ovarian response to controlled ovarian hyperstimulation during IVF and pregnancy outcome in patients who previously underwent laparoscopic cystectomy for endometriomas. Methods： There were 52 cases （65cycle） of in vitro fertiliation embryo transfer patients who had been removed ovarian endometriosis cyst by laparoscopy were included as study group, in which 20 cases experienced bilateral ectopic cystectomy and 32 cases underwent unilateral ectopic cystectomy. In contrast, 104 patients （129 cycles） with tubal-factor infertility were included as control group. The women in the study group and those in the control group underwent 65 and 129/VF-ET cycles, respectively. The related indices of ovarian response and pregnancy outcome were collected as statistical data for retrospective analysis. Results： There is no statistically difference among 3 group for the following parameters, such as age, body mass index, infertility years, basal FSH level, gonadotropin period, the fertilization rate and estradiol （E2） on the day of injecting human ehorionic gonadotropin （hCG） （P 〉 0.05）. Meanwhile there is slightly higher rate of pregnancy rate in the unilateral cyst removed group. The lower the retrieve follicles, good-quality embryonic rate and the frozen embryos, the higher the total gonadotropin requirements that were found in women with endometriosis compared with tubal-factor control subjects. In addition, the surgical side of retrieve follicles of the unilateral removed group was significantly lower than those in the unsurgical side ovary. Conclusion： The eystectomy for ovarian endometrioma has a negative impact on IVF-ET, resulting in an increase of the total amount of Gn, a decrease of the number of retrieved oocytes and good-quality embryo. Ectopie cystectomy do have some undesirable impact on IVF cycles, but there was no significant effect on the outcome of pregnancy.

关 键 词：卵巢子宫内膜异位囊肿 卵巢囊肿剥除术 体外受精-胚胎移植 妊娠结局 

分 类 号：R713[医药卫生—妇产科学] R714.8[医药卫生—临床医学]