Tasa acumulada de nacido vivo en pacientes con endometriosis

Jose María Puerta-Sanabria , Ana Clavero , María Carmen Gonzalvo , María Luisa López-Regalado , Bárbara Romero , Isabel Rodríguez , Juan Mozas , Juan Fontes , Luis Martínez , Andrea Pinto-Ibáñez , Silvia Copado , Jose Antonio Castilla
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Abstract

Introduction

Endometriosis is a disease characterised by the presence of endometrial cells outside the uterine cavity, leading to negative effects on the fertility of the woman. However, the mechanism whereby this occurs remains unclear.

Objective

A retrospective observational case-control study was conducted to compare the results of IVF/ICSI in women with endometriosis and male factor infertile couples, with the aim of finding evidence on the impact of endometriosis on the IVF/ICSI outcomes.

Material and methods

A study was carried out from 2009 to 2014, in which a total of 821 first cycles were performed on 156 patients with endometriosis, and 665 patients in whom the cause of infertility was due to pathology in their partner (male factor), and were considered as the control group. Ovarian stimulation parameters and IVF/ICSI outcomes were studied.

Results

Endometriosis patients required higher doses of FSH stimulation, subsequently yielding fewer oocytes and mature oocytes, although fertilisation rates were higher in these patients than in those with male factor. All cryopreservation parameters analysed were higher in male factor. No statistically significant results were obtained in other parameters analysed, such as the implantation rate, although the pregnancy and live birth rates analysed, especially the accumulated rate (fresh transfers + cryotransfers) were higher in all cases in the male factor, but without significance.

Discussion

This study suggests that endometriosis affects the success of IVF/ICSI by reducing the ovarian response to controlled stimulation, but neither oocyte quality nor endometrial receptivity are affected. It may be necessary to determine the factors that cause the decrease in ovarian follicle reserve, such as previous surgery, extent of disease, or previous drug treatments.

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子宫内膜异位症患者的累积活产率
子宫内膜异位症是一种以子宫腔外存在子宫内膜细胞为特征的疾病,对妇女的生育能力产生负面影响。然而,发生这种情况的机制尚不清楚。目的通过回顾性观察性病例对照研究,比较子宫内膜异位症患者与男性因素不育夫妇体外受精/ICSI结果,探讨子宫内膜异位症对体外受精/ICSI结果的影响。材料与方法本研究于2009 - 2014年对156例子宫内膜异位症患者进行了821次第一周期手术,其中665例因其伴侣病理(男性因素)导致不孕的患者作为对照组。研究卵巢刺激参数和IVF/ICSI结果。结果子宫内膜异位症患者需要更高剂量的卵泡刺激素刺激,随后产生更少的卵母细胞和成熟卵母细胞,尽管这些患者的受精率高于男性因素患者。所有冷冻保存参数的男性因子均较高。虽然分析了妊娠率和活产率,特别是累积率(新鲜移植+冷冻移植)在男性因素中均高于其他病例,但在着床率等其他参数分析中均无统计学意义。本研究提示子宫内膜异位症通过降低卵巢对控制刺激的反应影响IVF/ICSI的成功,但卵母细胞质量和子宫内膜容受性均未受到影响。可能有必要确定导致卵巢卵泡储备减少的因素,如既往手术,疾病程度或既往药物治疗。
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