PDF(Pubmed)
Abstract：
Does complete resection of endometriosis improve embryo quality as assessed by morphokinetic parameters using time-lapse microscopy?
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.
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.
摘要：
目的：使用延时显微镜通过形态动力学参数评估，子宫内膜异位症的完全切除是否可以改善胚胎质量？
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.
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.
