PDF(Sci-hub)
Abstract：
Deeply infiltrating endometriosis is a severe form of the disease, defined by endometriotic tissue peritoneal infiltration. The disease may involve the rectovaginal septum, uterosacral ligaments, digestive tract or bladder. Deeply infiltrating endometriosis is responsible for disabling pain and infertility. The purpose of these recommendations is to answer the following question: in case of deeply infiltrating endometriosis associated infertility, what is the best therapeutic strategy? First-line surgery and then in vitro fertilization (IVF) in case of persistent infertility or first-line IVF, without surgery? After exhaustive literature analysis, we suggest the following recommendations: studies focusing on spontaneous fertility of infertile patients with deeply infiltrating endometriosis found spontaneous pregnancy rates about 10%. Treatment should be considered in infertile women with deeply infiltrating endometriosis when they wish to conceive. First-line IVF is a good option in case of no operated deeply infiltrating endometriosis associated infertility. Pregnancy rates (spontaneous and following assisted reproductive techniques) after surgery (deep lesions without colorectal involvement) varie from 40 to 85%. After colorectal endometriosis resection, pregnancy rates vary from 47 to 59%. The studies comparing the pregnancy rates after IVF, whether or not preceded by surgery, are contradictory and do not allow, to date, to conclude on the interest of any surgical management of deep lesions before IVF. In case of alteration of ovarian reserve parameters (age, AMH, antral follicle count), there is no argument to recommend first-line surgery or IVF. The study of the literature does not identify any prognostic factors, allowing to chose between surgical management or IVF. The use of IVF in the indication \"deep infiltrating endometriosis\" allows satisfactory pregnancy rates without significant risk, regarding disease progression or oocyte retrieval procedure morbidity.
摘要：
深度浸润性子宫内膜异位症是一种严重的疾病，定义为子宫内膜异位组织腹膜浸润。这种疾病可能涉及直肠阴道隔，子宫骶骨韧带,消化道或膀胱。深度浸润性子宫内膜异位症是造成疼痛和不孕的原因。这些建议的目的是回答以下问题：在深度浸润的子宫内膜异位症相关的不孕症的情况下，什么是最好的治疗策略？一线手术，然后体外受精（IVF）在持续不孕症或一线IVF的情况下，没有手术？经过详尽的文献分析，我们提出以下建议:针对深度浸润性子宫内膜异位症不孕患者的自发生育研究发现,自发妊娠率约为10%.患有子宫内膜异位症的不孕妇女希望怀孕时应考虑治疗。在没有手术的深度浸润子宫内膜异位症相关的不孕症的情况下，一线IVF是一个很好的选择。手术后（无大肠受累的深部病变）的妊娠率（自发和以下辅助生殖技术）在40％至85％之间变化。结直肠子宫内膜异位症切除术后，怀孕率从47%到59%不等。比较IVF后怀孕率的研究，无论之前是否手术，是矛盾的，不允许，到目前为止,总结试管婴儿前任何深部病变手术治疗的兴趣。在卵巢储备参数改变的情况下（年龄，AMH,窦卵泡计数)，没有理由推荐一线手术或IVF。文献研究没有确定任何预后因素，允许在手术管理或IVF之间进行选择。在“深层浸润性子宫内膜异位症”的适应症中使用IVF可以使妊娠率令人满意，而没有明显的风险，关于疾病进展或卵母细胞取出程序发病率。
