子宮腺肌症對於IVF有不良影響

施行超長療程結果優於長療程

The impact of adenomyosis on IVF in infertile women with normal ovarian reserve following long or ultra-long GnRH-agonist treatment.

Open AccessPublished:August 01, 2020DOI:https://doi.org/10.1016/j.rbmo.2020.07.027

Does adenomyosis impact IVF independent of decreased ovarian reserve, and what are the characteristics and IVF outcome of ultra-long GnRH-agonist protocol in adenomyosis༟

Design

We carried out an observational cohort study with three groups of patients who were treated with IVF. Group A:362 patients with adenomyosis using the ultra-long GnRH-agonist protocol. Group B:127 patients with adenomyosis using the long GnRH-agonist protocol. Group C: 3,471 patients with tubal infertility using the long GnRH-agonist protocol. All patients were the first IVF treatment cycle and presented with normal ovarian reserve.

Results

(1) Compared with groups B and C, the number of oocytes retrieved in group A decreased, and the Gn(gonadotrophin) dosage and Gn duration in group A were higher, (p<0.05). (2) In long GnRH-agonist treatment, the clinical pregnancy rate(OR 0.492, 95%CI 0.327-0.742, P<0.001),implantation rate(OR 0.527, 95%CI 0.350-0.794, P=0.002) and live birth rate(OR 0.442, 95%CI 0.291-0.673, P<0.001) decreased and abortion rate(OR 3.078, 95%CI 1.593–5.948, P<0.001) increased in adenomyosis patients compared with tubal infertility. (3) For adenomyosis patients, clinical pregnancy rate(OR 1.925, 95%CI 1.137–3.250, P=0.015),implantation rate(OR 1.694, 95%CI 1.006-2.854, P=0.047) and live birth rate(OR 1.704, 95%CI 1.012–2.859, P=0.044) increased in the ultra-long GnRH-agonist treatment compared with long GnRH-agonist treatments

Conclusion

Adenomyosis could have a negative impact on IVF outcomes independent of ovarian reserve following long GnRH-agonist protocol. Adenomyosis patients experiencing ultralong GnRH-agonist protocol could have a better pregnancy outcome than those undergoing long GnRH-agonist protocol.