子宮內膜異位瘤切除手術會影響IVF懷孕率

雙側子宮內膜異位瘤IVF前施行子宮內膜異位瘤切除手術會影響IVF懷孕率
(手術懷孕率 vs.非手術懷孕率=7% vs. 19% )

http://humrep.oxfordjournals.org/content/23/7/1526.full

IVF–ICSI outcome in women operated on for bilateral endometriomas

1. Edgardo Somigliana1, 
2. Mariangela Arnoldi1,2, 
3. Laura Benaglia1,2,3,
4. Roberta Iemmello1,2, 
5. Anna Elisa Nicolosi1,2 and 
6. Guido Ragni1

+Author Affiliations

1. ¹Infertility Unit, Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via M. Fanti 6, 20122 Milan, Italy
2. ²Università degli Studi di Milano, Milan, Italy

1. 3Correspondence address. Tel: +39-02-55034303; Fax: +39-02-55034302. E-mail:laurabenaglia@hotmail.it

• Received December 18, 2007.
• Revision received February 11, 2008.
• Accepted March 28, 2008.

 

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Abstract

BACKGROUND The influence of previous conservative surgery for endometriomas on IVF–ICSI outcome is debated. Conflicting information emerging from the literature may be consequent to the fact that endometriomas are mostly monolateral. The contralateral intact ovary may adequately supply for the reduced function of the affected one. To clarify this point, we assess IVF–ICSI outcome in women operated on for bilateral endometriomas.

METHODS Women selected for IVF–ICSI cycles who previously underwent bilateral endometriomas cystectomy were matched (1:2) for age and study period with patients who did not undergo prior ovarian surgery.

RESULTS Sixty-eight cases and 136 controls were recruited. Women operated on for bilateral endometriotic ovarian cysts had a higher withdrawal rate for poor response (P < 0.001). In these patients, despite the use of higher doses of gonadotrophins, the number of follicles (P = 0.006), oocytes retrieved (P = 0.024) and embryos obtained (P = 0.024) were significantly lower. The clinical pregnancy rate per started cycle in cases and controls was 7% and 19% (P = 0.037) and the delivery rate per started cycle was 4% and 17%, respectively (P = 0.013).

CONCLUSIONS IVF outcome is significantly impaired in women operated on for bilateral ovarian endometriomas.

IVF–ICSI outcome in women operated on for bilateral endometriomas

Table III.

Characteristics of the IVF–ICSI cycles in patients operated for bilateral endometriomas (cases) and controls.

Characteristics	Cases (n = 68)	Controls (n = 136)	p
Cancelled cycle			<0.001
Hyper-response	1 (2%)	20 (15%)
Poor response	17 (28%)	8 (6%)
Dosage of rFSH/die	333 ± 133	212 ± 112	<0.001
Duration of stimulation (day)a	11.5 ± 2.3	11.8 ± 2.4	0.58
Number of follicles 11–15 mma	3.2 ± 2.8	4.6 ± 3.3	0.009
Number of follicles>15 mma	5.2 ± 2.8	6.5 ± 2.7	0.006
Number of oocyte retrieveda	5.7 ± 4.0	7.2 ± 3.6	0.024
Number of oocyte useda,b	2.8 ± 2.3	3.8 ± 2.7	0.034
Number of embryos obtaineda,b	2.0 ± 1.9	2.8 ± 2.0	0.024
Number of transfers not performeda	14 (28%)	16 (15%)	0.08
Number of embryos transferredc	2.0 ± 0.6	2.2 ± 0.7	0.20
Clinical pregnancy rate (PR)
Number of pregnancies	5	26
PR per starting cycle	7%	19%	0.037
PR per oocyte retrieval	10%	24%	0.051
PR per embryo transfer	14%	28%	0.11
Implantation rate	5 (7%)	33 (16%)	0.048
Delivery rate (DR)
Number of deliveries	3	23
DR per starting cycle	4%	17%	0.013
DR per oocyte retrieval	6%	21%	0.02
DR per embryo transfer	8%	25%	0.049

• ^aData refer to patients undergoing oocyte retrieval.
• ^bThe number of oocytes retrieved and oocytes used differ due to the new Italian legislation that since March 2004 bans the use of more than three oocytes.
• ^cData refer to patients performing embryo transfer.