Influence Factor Analysis Of Postoperative Pregnancy In Patients Of Endometriosis Associated Infertility After Laparoscopy Combined With Hysteroscopy Surgery

ObjectiveTo probe into the pregnancy outcome after laparoscopy combined with hysteroscopy surgery in patients of endometriosis associated infertility and the clinical factors influencing the postoperative pregnancy rate.MethodsRetrospectively cohort study.419 patients with endometriosis associated infertility who underwent laparoscopy combined with hysteroscopy surgery in Maternal and Child Health Care Hospital of XiaMen from April in 2012 to April in 2014 were followed up to April in 2016 to assess fertility outcome.All patients were meet the inclusion and exclusion criterias,and were grouped into two groups according to fertility outcome。All the clinical factors,including age、infertility time、infertility type、BMI、abdominal operation history、r-AFS stage、pathological type、auxiliary medication、ovarian stimulation treatment,were retrospectively analyzed the relationship with postoperative pregnancy rate.All patients were classified into ART group and natural pregnancy group according to ART or not,and respectively compare their postoperative pregnancy rate,as well as clinical factors.Results1.365(87.11%)patients were followed up,and the overall postoperative pregnancy rate was 55.07%(201/365).The postoperative pregnancy rate was 36.71%、15.07%、2.74%、0.55%、0.00%in the sixth,twelfth,twenty-fourth,thirty-sixth and forty-eighth months respectively.There were significant differences among the five groups(P<0.05).2.365 patients were divided into pregnancy group and non-pregnancy group,the age ≥35,infertility time ≥3,Ⅲ-Ⅳ stages,.deeply-infiltrating endometriosis are risk factors of postoperative pregnancy rate(OR=3.11、2.39、2.97、2.35,P<0.05),and secondary infertility is protective factor(OR=0.39,P<0.05).3.365 patients were divided into ART group and natural pregnancy group,and there was no difference between two groups in postoperative pregnancy rate(P>0.05),while ART group has higher age、infertility time and r-AFS stage than natural pregnancy group(P<0.05).4.In 73 patients of ART group after surgery,36 of them got pregnancy(49.32%).The age ≥35,infertility time ≥3,Ⅲ-Ⅳ stages are risk factors of postoperative pregnancy rate(OR=5.11、4.77、1.87,P<0.05),and secondary infertility is protective factor(OR=0.23,P<0.05).5.1n 292 patients of natural pregnancy group after surgery,165 of them got pregnancy(56.51%).the age ≥35,infertility time ≥3,Ⅲ-Ⅳ stages are risk factors of postoperative pregnancy rate(OR=10.45、3.03、3.74,P<0.05),and secondary infertility,applying ovarian stimulation treatment are protective factors(OR=0.23、0.33,P<0.05).Conclusions1.Laparoscopy combined with hysteroscopy surgery can increase postoperative pregnancy rate,and the best time to pregnancy is the first one year after surgery.2.The age、infertility time、infertility type、r-AFS stage、pathological type may be associated with postoperative pregnancy rate.Applying auxiliary medication has nothing to do with natural pregnancy rate,while applying ovarian stimulation treatment can increase natural pregnancy rate.3.The patients of Ⅰ-Ⅱ stages can be given opportunities to natural conception for 6 months to 12 months,if the natural pregnancy tried fail for pregnant in one year,orapplying assisted reproductive technology to improve pregnancy rate is recommended.The patients of Ⅲ-Ⅳ stages should assess ovarian reserve function actively and applying assisted reproductive technology to strive for pregnancy in one year.