For this retrospective study we analysed 237 fertilised, cultured and transferred embryos from 128 fresh IVF and/ or ICSI transfer cycles. Endometriosis was confirmed or excluded by laparoscopy. Patients were stimulated with recombinant FSH using GnRH agonist and antagonist protocols. After fertilisation, a time-lapse incubation system was used for observation. Embryo quality was assessed using the KIDScore™ D3 and D5 implantation data algorithm.
The analysis showed a median KIDScore™ D5 of 2.6 (on a scale of 1 to 9.9) for embryos from patients with endometriosis without complete resection. The control group without endometriosis achieved a score of 6.8 (p = 0.003). The median score for embryos from endometriosis patients with complete resection was 7.2, which was a significant increase compared to embryos from patients without complete resection (p = 0.002). We observed an effect size of r = 0.4 for complete resection versus no resection of endometriosis using the KIDScore™ D5. There were no differences in KIDScore™ D3 between the three patient groups. Pregnancy and miscarriage rates showed the same clinical trends. In three of our four case series of patients who underwent IVF/ ICSI cycles before and after complete resection, we found a marked improvement in embryo quality after complete resection.
Complete resection of endometriosis could significantly improve the otherwise poor embryo quality of patients undergoing IVF-procedures. The data, therefore, strongly support recommending surgery to patients with endometriosis prior to assisted reproduction.
方法:在这项回顾性研究中,我们分析了237个受精,来自128个新鲜IVF和/或ICSI移植周期的培养和移植胚胎。腹腔镜检查证实或排除子宫内膜异位症。使用GnRH激动剂和拮抗剂方案用重组FSH刺激患者。受精后,使用延时孵育系统进行观察。使用KIDScore™D3和D5植入数据算法评估胚胎质量。
结果:分析显示,未完全切除的子宫内膜异位症患者的胚胎的KIDScore™D5中位数为2.6(1至9.9)。无子宫内膜异位症的对照组评分为6.8(p=0.003)。完全切除子宫内膜异位症患者胚胎的中位数评分为7.2,与未完全切除的患者胚胎相比显着增加(p=0.002)。我们使用KIDScore™D5观察到子宫内膜异位症的完全切除与不切除的效果大小r=0.4。三个患者组之间的KIDScore™D3没有差异。妊娠和流产率表现出相同的临床趋势。在我们的四个病例系列中,有三个在完全切除之前和之后接受了IVF/ICSI周期的患者,我们发现完全切除后胚胎质量有显著改善.
结论:完全切除子宫内膜异位症可显著改善IVF手术患者胚胎质量较差的情况。数据,因此,强烈支持子宫内膜异位症患者在辅助生殖前推荐手术治疗.