摘要目的 探讨盆腔子宫内膜异位症(EMS)合并不孕患者行腹腔镜手术治疗后影响体外受精-胚胎移植(IVF-ET)妊娠结局的因素.方法 回顾性队列研究分析2015年1月-2017年10月期间在河南省生殖医院首次接受IVF-ET助孕且有腹腔镜下盆腔EMS手术史的256例不孕患者的临床资料,采用单因素分析和logistic多因素分析影响术后IVF累积妊娠结局的因素.结果 ①共163例患者获得临床妊娠,累积妊娠率为61.51％.单因素分析显示,基础窦卵泡计数(AFC)、美国生殖学会EMS的分期(r-AFS)、EMS生育指数(EFI)评分、手术时年龄、促排卵方案、获卵数、可利用胚胎数与术后累积妊娠率相关(P＜0.05);②Logistic多因素回归分析结果显示,年龄≥40岁(OR=0.188,P=0.013)、r-AFS分期高(OR=0.211,P=0.001)、EFI评分≤8分(OR=0.302,P=0.002)、双侧卵巢EMS异位囊肿(OR=0.427,P=0.048)、手术距离IVF时间＞3年(OR=0.513,P=0.041)为IVF累积妊娠率的危险性因素,降调节促排卵方案(OR=6.489,P=0.001)和可移植胚胎数多(OR=1.729,P=0.001)为IVF累积妊娠率的保护性因素;③术后随着时间延长,IVF累积妊娠率逐渐下降(P=0.041).结论 高龄(≥40岁)、r-AFS分期高、双侧卵巢EMS异位囊肿、手术距离IVF时间长、非降调节促排卵方案和可移植胚胎数少是EMS合并不孕患者腹腔镜术后IVF累积妊娠率的独立危险因素.综合评估病情,缩短腹腔镜手术后助孕等待时间,可以获得更理想的IVF-ET妊娠结局.

abstractsObjective To analyze the multiple factors related to in vitro fertilization-embryo transfer (IVF-ET) pregnancy outcomes in infertile patients with pelvic endometriosis (EMS) after the laparoscopic surgery.Methods We collected 265 cases of EMS with infertility that received the first IVF-ET treatment after laparoscopic in Henan Reproductive Hospital from Jan.2015 to Oct.2017.Univariate analysis and multivariate logistic regression analysis were used to analyze the factors related to IVF cumulative pregnancy rate after surgery.Results 1) Totally 165 cases were pregnant and the overall cumulative clinical pregnancy rate was 61.51％.Univariate analysis showed that antral follicle count (AFC),revised American Fertility Society (r-AFS) stage,endometriosis fertility index (EFI) score,age of the surgery,excision of ovary EMS in operation,time interval between surgery and IVF,controlled ovulation stimulation (COS) protocol,oocytes retrieved,available embryos were related to IVF cumulative pregnancy rate (P＜0.05).2) The logistic multivariate regression analysis showed that age ≥ 40 years (OR=0.188,P=0.013),high level r-AFS stage (OR=0.211,P=0.001),EFI score less than 8 (OR=0.302,P=0.002),dual ovary EMS excision (OR=0.427,P=0.048),time interval ＞3 years (OR=0.513,P=0.041) were the risk factors of postoperative IVF cumulative pregnancy rate.Downregulation protocol (OR=6.489,P=0.001),and more available embryos (OR=1.729,P=0.001) were the protective factors of postoperative IVF cumulative pregnancy rate.3) The rate of IVF cumulative pregnancy rate was decreased gradually with the postoperative time (P=0.041).Conclusion The advanced age,high level r-AFS stage,low EFI score,long time interval,non-downregulation protocol,less available embryos are important risk factors affecting postoperative IVF pregnancy outcomes in those patients with EMS after laparoscopic treatment.Comprehensive assessment and shortening the waiting time after laparoscopic surgery can achieve a more ideal IVF-ET pregnancy outcome.