目的:严重的子宫内膜异位症相关疼痛症状是否影响ART活产率?
结论:严重的疼痛症状与子宫内膜异位症患者ART活产率降低无关。
背景:ART目前被认为是治疗子宫内膜异位症相关不孕症的主要治疗选择之一。目前,文献中没有关于疾病核心症状之间关联的数据,例如疼痛和ART生殖结果。
方法:354例子宫内膜异位症患者的观察性队列研究,他在三级护理大学医院接受了ART,2014年10月至2021年10月。子宫内膜异位症的诊断基于已发表的影像学标准,使用经阴道超声和磁共振成像,在有子宫内膜异位症手术史的女性中经组织学证实(n=127,35.9%).
方法:与痛经(DM)相关的疼痛症状的强度,性交困难(DP),非循环性慢性盆腔疼痛,胃肠(GI)疼痛,使用10点视觉模拟量表(VAS)评估或下尿路疼痛,在艺术之前严重疼痛被定义为对于至少一种症状具有7或更高的VAS。主要结局指标是每位患者的累积活产率(CLBR)。我们使用单变量和多变量分析分析了子宫内膜异位症相关疼痛症状对ART活产的影响。
结果:三百五十四名子宫内膜异位症患者接受了711个ART周期。人口平均年龄为33.8±3.7岁,不孕的平均病程为3.6±2.1年。子宫内膜异位症表型的分布为浅表子宫内膜异位症的3.1%,8.2%卵巢子宫内膜瘤,88.7%深部浸润型子宫内膜异位症。DM的平均VAS评分,DP,和胃肠道疼痛症状分别为6.6±2.7、3.4±3.1和3.1±3.6。42例患者(68.4%)有严重的疼痛症状。每位患者的CLBR为63.8%(226/354)。在有活产的患者和没有活产的患者之间,各种疼痛症状的平均VAS评分和表现出严重疼痛的患者比例都没有显着差异,基于单变量和多变量分析(P=0.229)。与ART阴性活产相关的唯一重要因素是年龄>35岁(P<0.001)和抗苗勒管激素水平<1.2ng/ml(P<0.001)。
结论:子宫内膜异位症的诊断是基于影像学而不是手术。这个限制是,然而,大多数子宫内膜异位症患者首先恢复ART的研究设计固有的。
结论:与其考虑诸如疼痛之类的单一论点,子宫内膜异位症不孕患者选择ART和手术的决策过程应基于多个方面,包括病人的选择,相关的不孕因素,子宫内膜异位症的表型,以及药物治疗疼痛症状的效率,通过由多学科专家团队指导的个性化方法。
背景:没有资金;没有利益冲突。
背景:不适用。
OBJECTIVE: Do severe endometriosis-related painful symptoms impact ART live birth rates?
CONCLUSIONS: Severe pain symptoms are not associated with reduced ART live birth rates in endometriosis patients.
BACKGROUND: ART is currently recognized as one of the main therapeutic options to manage endometriosis-related infertility. Presently, no data exist in the literature regarding the association between the core symptom of the disease, e.g. pain and ART reproductive outcomes.
METHODS: Observational cohort study of 354 endometriosis patients, who underwent ART at a tertiary care university hospital, between October 2014 and October 2021. Diagnosis of endometriosis was based on published imaging criteria using transvaginal sonography and magnetic resonance imaging, and histologically confirmed in women who had a previous history of endometriosis surgery (n = 127, 35.9%).
METHODS: The intensity of painful symptoms related to dysmenorrhea (DM), dyspareunia (DP), noncyclic chronic pelvic pain, gastrointestinal (GI) pain, or lower urinary tract pain was evaluated using a 10-point visual analog scale (VAS), before ART. Severe pain was defined as having a VAS of 7 or higher for at least one symptom. The main outcome measure was the cumulative live birth rate (CLBR) per patient. We analyzed the impact of endometriosis-related painful symptoms on ART live births using univariable and multivariate analysis.
RESULTS: Three hundred and fifty-four endometriosis patients underwent 711 ART cycles. The mean age of the population was 33.8 ± 3.7 years, and the mean duration of infertility was 3.6 ± 2.1 years. The distribution of the endometriosis phenotypes was 3.1% superficial endometriosis, 8.2% ovarian endometrioma, and 88.7% deep infiltrating endometriosis. The mean VAS scores for DM, DP, and GI pain symptoms were 6.6 ± 2.7, 3.4 ± 3.1, and 3.1 ± 3.6, respectively. Two hundred and forty-two patients (68.4%) had severe pain symptoms. The CLBR per patient was 63.8% (226/354). Neither the mean VAS scores for the various painful symptoms nor the proportion of patients displaying severe pain differed significantly between patients who had a live birth and those who had not, based on univariate and multivariate analyses (P = 0.229). The only significant factors associated with negative ART live births were age >35 years (P < 0.001) and anti-Müllerian hormone levels <1.2 ng/ml (P < 0.001).
CONCLUSIONS: The diagnosis of endometriosis was based on imaging rather than surgery. This limitation is, however, inherent to the design of most studies on endometriosis patients reverting to ART first.
CONCLUSIONS: Rather than considering a single argument such as pain, the decision-making process for choosing between ART and surgery in infertile endometriosis patients should be based on a multitude of aspects, including the patient\'s choice, the associated infertility factors, the endometriosis phenotypes, and the efficiency of medical therapies in regard to pain symptoms, through an individualized approach guided by a multidisciplinary team of experts.
BACKGROUND: No funding; no conflict of interest.
BACKGROUND: N/A.