Pain after oocyte retrieval in women with endometriosis undergoing fertility preservation or IVF

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY Reproductive biomedicine online Pub Date : 2024-05-03 DOI:10.1016/j.rbmo.2024.104100

Maha Eid , Adrien Lemoine , Lena Bardet , Lise Selleret , Sophie Stout , Emmanuelle Mathieu d'Argent , Anna Ly , Nathalie Sermondade , Cyril Touboul , Charlotte Dupont , Nathalie Chabbert-Buffet , Kamila Kolanska

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Abstract

Research question

Do women with endometriosis undergoing oocyte retrieval for fertility preservation experience the same level of pain as women undergoing oocyte retrieval for IVF?

Design

This retrospective cohort study included 796 cycles in women with endometriosis undergoing oocyte retrieval for fertility preservation (n = 401) or IVF (n = 395) between January 2020 and October 2022. Post-operative pain assessments were compared between the two groups using a numeric rating scale (NRS).

Results

Women in the fertility preservation group were younger (32.1 ± 4.2 years versus 35.1 ± 4.1 years; P < 0.001), had a lower body mass index (22.8 ± 3.9 kg/m² versus 24.6 ± 4.4 kg/m²; P < 0.001) and had a lower concentration of anti-Müllerian hormone (1.8 ± 1.5 ng/ml versus 2.15 ± 2.11 ng/ml; P = 0.026) in comparison with women in the IVF group. The oestrogen concentration on the day of ovulation trigger was higher in women in the fertility preservation group (2188 ± 1152 pg/ml versus 2081 ± 995 pg/ml; P = 0.004), and the prevalence rates of adenomyosis and digestive endometrial lesions were lower in women in the fertility preservation group (14% versus 29%, P < 0.001; 16% versus 25%, P = 0.003, respectively) compared with women in the IVF group. After oocyte puncture, more women in the fertility preservation group had an NRS pain score >3 (moderate to severe pain) compared with women in the IVF group (20% versus 14%; P = 0.018). The progestin-primed ovarian stimulation (PPOS) protocol was identified as an independent predictive factor of greater post-operative pain (adjusted OR 2.30, 95% CI 1.06–5.15; P = 0.039).

Conclusion

Women with endometriosis undergoing fertility preservation reported more intense post-operative pain in the recovery room than women undergoing IVF. The PPOS protocol was an independent risk factor of intense pain (NRS pain score >3) in women with endometriosis, but further studies are needed to confirm this result.

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患有子宫内膜异位症、接受生育力保存或体外受精的妇女取卵后的疼痛

研究问题为保留生育力而进行取卵术的子宫内膜异位症女性与为体外受精而进行取卵术的女性是否会经历相同程度的疼痛？设计这项回顾性队列研究纳入了2020年1月至2022年10月期间为保留生育力而进行取卵术（401人）或体外受精（395人）的796个周期的子宫内膜异位症女性。使用数字评分量表（NRS）对两组患者的术后疼痛评估进行比较。结果保留生育力组的女性更年轻（32.1 ± 4.2 岁对 35.1 ± 4.1 岁；P < 0.001），体重指数较低（22.8 ± 3.9 kg/m2 对 24.6 ± 4.4 kg/m2；P <；0.001），抗缪勒氏管激素浓度较低（1.8 ± 1.5 ng/ml 对 2.15 ± 2.11 ng/ml；P = 0.026）。与试管婴儿组相比，生育力保存组妇女在排卵触发日的雌激素浓度更高（2188 ± 1152 pg/ml 对 2081 ± 995 pg/ml；P = 0.004），腺肌症和消化道子宫内膜病变的发生率也更低（分别为 14% 对 29%，P < 0.001；16% 对 25%，P = 0.003）。卵母细胞穿刺后，NRS 疼痛评分为 3 分（中度至重度疼痛）的生育力保存组女性多于试管婴儿组女性（20% 对 14%；P = 0.018）。孕激素刺激卵巢（PPOS）方案是导致术后疼痛加剧的独立预测因素（调整后 OR 2.30，95% CI 1.06-5.15；P = 0.039）。PPOS方案是导致子宫内膜异位症妇女剧烈疼痛（NRS疼痛评分3分）的一个独立风险因素，但这一结果还需要进一步研究证实。

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来源期刊

Reproductive biomedicine online 医学-妇产科学

CiteScore

7.20

自引率

7.50%

发文量

391

审稿时长

50 days

期刊介绍： Reproductive BioMedicine Online covers the formation, growth and differentiation of the human embryo. It is intended to bring to public attention new research on biological and clinical research on human reproduction and the human embryo including relevant studies on animals. It is published by a group of scientists and clinicians working in these fields of study. Its audience comprises researchers, clinicians, practitioners, academics and patients. Context: The period of human embryonic growth covered is between the formation of the primordial germ cells in the fetus until mid-pregnancy. High quality research on lower animals is included if it helps to clarify the human situation. Studies progressing to birth and later are published if they have a direct bearing on events in the earlier stages of pregnancy.