不同分期子宫内膜异位症对体外受精-胚胎移植结局的影响OA
Influence of Endometriosis at Different Stages on the Outcome of In Vitro Fertilization-Embryo Transfer
目的:探讨不同分期子宫内膜异位症(EMS)对体外受精/卵胞浆内单精子注射(IVF/ICSI)-胚胎移植结局的影响.方法:回顾性分析2015年1月—2023年10月于宜昌市中心人民医院行IVF/ICSI-胚胎移植助孕的患者资料共579例.根据不孕因素分为Ⅰ-Ⅱ期EMS组(n=32)、Ⅲ-Ⅳ期EMS组(n=73)、未手术EMS组(n=72)及输卵管因素不孕组(n=402),比较组间促排卵情况、实验室和临床妊娠结局等.结果:Ⅲ-Ⅳ期EMS组促性腺激素释放激素激动剂(GnRHa)用量为(5.38±3.70)mg,较输卵管因素不孕组[(3.98±1.45)mg]、Ⅰ-Ⅱ 期 EMS 组[(4.13±2.33)mg]和未手术EMS组[(4.51±2.98)mg]明显增加(均P＜0.05),促性腺激素用量、扳机日雌二醇水平、优势卵泡个数(≥14 mm)及卵泡输出率差异无统计学意义(均P＞0.05).Ⅲ-Ⅳ期EMS组获卵数为(8.99±4.62)个,明显低于输卵管因素不孕组[(11.40±5.73)个]和未手术EMS组[(10.92±5.35)个](均P＜0.05),成熟卵母细胞率、二原核率及优质胚胎率等差异无统计学意义(均P＞0.05).助孕结局比较,首次胚胎移植的临床妊娠率、单个促排卵周期累积妊娠率和活产率差异均无统计学意义(均P＞0.05).结论:本研究数据不支持不同分期EMS对于IVF/ICSI的胚胎质量和临床结局有不利影响.对于Ⅲ-Ⅳ期EMS在实施IVF/ICSI时采用GnRHa超长方案可能存在一定益处,该组获卵数较输卵管因素不孕组虽减少,但能收获较其他组相似的累积妊娠率和活产率.
Objective:To investigate the effects of endometriosis(EMS)at different stages on the outcomes of in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)-embryo transfer.Methods:A total of 579 patients who underwent IVF/ICSI-embryo transfer in Yichang Central People's Hospital from January 2015 to October 2023 were retrospectively analyzed.They were divided into four groups according to infertility factors:stage Ⅰ-Ⅱ EMS(n=32),Ⅲ-Ⅳ EMS(n=73),non-surgical EMS(n=72)and the tubal factor infertility group(n=402).The ovulation induction conditions,as well as the laboratory and clinical pregnancy-assisting outcomes between the groups were compared.Results:In the stage Ⅲ-Ⅳ EMS group,the GnRHa dosage[(5.38±3.70)mg]was higher than that of the tubal factor infertility group[(3.98±1.45)mg],stage Ⅰ-Ⅱ EMS group[(4.13±2.33)mg],and non-surgical EMS group[(4.51±2.98)mg](all P＜0.05),but there was no significant difference in gonadotropin dosage,estradiol level on the trigger day,number of dominant follicles(≥14 mm),and follicle output rate(all P＞0.05).Moreover,the number of eggs retrieved in stage Ⅲ-Ⅳ EMS group(8.99±4.62)was significantly lower than that of the tubal factor infertility group(11.40±5.73)and non-surgical EMS group(10.92±5.35)(both P＜0.05),but there was no significant difference in mature oocytes rate,two pronucleus rate and high-quality embryo rate(all P＞0.05).There was no significant difference in the clinical pregnancy rate of the first embryo transferation,the cumulative pregnancy rate and the live birth rate of a single ovulation induction cycle among groups(all P＞0.05).Conclusion:This study do not support that EMS at different stage has adverse effects on the embryo quality and clinical outcomes of IVF/ICSI.For stage Ⅲ-Ⅳ EMS,GnRHa ultra-long protocol may have benefits in IVF/ICSI.Although the number of retrieved oocytes in this group is lower than that in the the tubal factor infertility group,similar cumulative pregnancy rates and live birth rates can be achieved compared with other groups.
祁晓晨;郑婷婷;李琴华;叶红
三峡大学第一临床医学院[宜昌市中心人民医院]生殖医学中心&三峡大学妇产科学研究所,湖北宜昌 443003三峡大学第一临床医学院[宜昌市中心人民医院]生殖医学中心&三峡大学妇产科学研究所,湖北宜昌 443003三峡大学第一临床医学院[宜昌市中心人民医院]生殖医学中心&三峡大学妇产科学研究所,湖北宜昌 443003三峡大学第一临床医学院[宜昌市中心人民医院]生殖医学中心&三峡大学妇产科学研究所,湖北宜昌 443003
医药卫生
子宫内膜异位症体外受精长方案妊娠率
endometriosis(EMS)in vitro fertilization(IVF)long protocolpregnancy rate
《巴楚医学》 2026 (1)
38-44,7
国家自然科学基金项目(82104589)
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