METHODS: Observational cohort study of three groups of patients undergoing first cycle of IVF treatment with normal ovarian reserve: (A) 362 patients with adenomyosis using the ultra-long GnRH agonist protocol; (B) 127 patients with adenomyosis using the long GnRH agonist protocol; (C) 3471 patients with tubal infertility using the long GnRH agonist protocol.
RESULTS: Compared with groups B and C, the number of oocytes retrieved in group A decreased, and the gonadotrophin dosage and duration in group A were higher (P < 0.001). In long GnRH agonist treatment, clinical pregnancy rate (OR 0.492, 95% CI 0.327 to 0.742, P < 0.001), implantation rate (OR 0.527, 95% CI 0.350 to 0.794, P = 0.002) and live birth rate (OR 0.442, 95% CI 0.291 to 0.673, P < 0.001) decreased and miscarriage rate (OR 3.078, 95% CI 1.593 to 5.948, P < 0.001) increased in adenomyosis patients compared with tubal infertility. For adenomyosis patients, clinical pregnancy rate (OR 1.925, 95% CI 1.137 to 3.250, P = 0.015), implantation rate (OR 1.694, 95% CI 1.006 to 2.854, P = 0.047) and live birth rate (OR 1.704, 95% CI 1.012 to 2.859, P = 0.044) increased in the ultra-long GnRH agonist treatment compared with long GnRH agonist treatments.
CONCLUSIONS: Adenomyosis could negatively affect IVF outcomes independent of ovarian reserve after long GnRH agonist protocol. Patients with adenomyosis following the ultra-long GnRH agonist protocol could have a better pregnancy outcome than those following the long GnRH agonist protocol.
方法:对三组患者进行观察性队列研究,这些患者接受了第一轮IVF治疗,卵巢储备正常:(A)使用超长GnRH激动剂方案的362例子宫腺肌病患者;(B)使用长Gntuble激动剂方案的127例。
结果:与B组和C组相比,A组的卵母细胞数量减少,A组促性腺激素用量和持续时间较高(P<0.001)。在长期GnRH激动剂治疗中,临床妊娠率(OR0.492,95%CI0.327~0.742,P<0.001),与输卵管性不孕症相比,子宫腺肌病患者的种植率(OR0.527,95%CI0.350至0.794,P=0.002)和活产率(OR0.442,95%CI0.291至0.673,P<0.001)降低,流产率(OR3.078,95%CI1.593至5.948,P<0.001)增加。对于子宫腺肌病患者,临床妊娠率(OR1.925,95%CI1.137~3.250,P=0.015),与长GnRH激动剂治疗相比,超长GnRH激动剂治疗的植入率(OR1.694,95%CI1.006至2.854,P=0.047)和活产率(OR1.704,95%CI1.012至2.859,P=0.044)增加。
结论:子宫腺肌病可对IVF结局产生负面影响,而与长期GnRH激动剂方案后的卵巢储备无关。遵循超长GnRH激动剂方案的子宫腺肌病患者可能比遵循长GnRH激动剂方案的患者具有更好的妊娠结局。