Abstract:
Endometriosis-related infertility is one of the most debated topics in reproductive medicine. In recent years, prolonged pre-cycle hormonal regimens gained attention as a mean of improving the assisted reproduction technologies (ART) success rates in endometriosis patients. GnRH agonists, dienogest, medroxyprogesterone acetate, and aromatase inhibitors are the most studied medications. Conflicting results and a high risk of bias exist in almost all of the conducted studies in the field. However, current evidence suggests that pre-cycle treatment with GnRH agonists may be beneficial for patients with stage III/IV endometriosis. Dienogest and medroxyprogesterone acetate-based progestin-primed ovarian stimulation protocol was shown to be comparable to the prolonged GnRH agonists protocol. Finally, aromatase inhibitors seem to be of limited benefit to the assisted reproductive outcomes of endometriosis patients. Although it is challenging to draw any clinical conclusions, pre-cycle hormonal treatments seem to be best indicated in endometriosis patients who had previously failed ART treatment.
摘要:
子宫内膜异位症相关的不孕症是生殖医学中最有争议的话题之一。近年来,延长周期前激素治疗方案作为提高子宫内膜异位症患者辅助生殖技术(ART)成功率的手段而备受关注.GnRH激动剂,Dienogest,醋酸甲羟孕酮,芳香酶抑制剂是研究最多的药物。在该领域进行的几乎所有研究中都存在矛盾的结果和高偏倚风险。然而,目前的证据表明,GnRH激动剂的周期前治疗可能对III/IV期子宫内膜异位症患者有益.显示基于Dienogest和醋酸甲羟孕酮的孕激素引发的卵巢刺激方案与延长的GnRH激动剂方案相当。最后,芳香化酶抑制剂对子宫内膜异位症患者的辅助生殖结局的益处似乎有限。尽管得出任何临床结论都是具有挑战性的,在先前ART治疗失败的子宫内膜异位症患者中,周期前激素治疗似乎最适合.