PDF(Sci-hub)
Abstract：
OBJECTIVE: Does adenomyosis affect IVF independent of decreased ovarian reserve, and what are the characteristics and IVF outcome of the ultra-long gonadotrophin-releasing hormone (GnRH) agonist protocol in adenomyosis?
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.
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.
摘要：
目的：子宫腺肌病是否独立于卵巢储备功能下降而影响IVF，子宫腺肌病超长促性腺激素释放激素（GnRH）激动剂方案的特征和IVF结局是什么？
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。
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。
