| Objective:To investigate the effect of laparoscopic ovarian endometriosis cystectomy and non-operative treatment on the outcomes of assisted reproduction in patients with ovarian endometriosis cysts with a diameter of 4-6cm and infertility,in order to provide a reference for the treatment plan for such patients,choose the most suitable assisted pregnancy program,increase the pregnancy rate and improve the pregnancy outcome.Methods:A retrospective analysis was made of women with ovarian endometrioma（4-6cm in diameter）combined with infertility and IVF assisted pregnancy who visited the Reproductive Center of the Second Hospital of Jilin University from June 2016 to June 2021,and a total of 89 cases who met the inclusion and exclusion criteria were selected.According to whether laparoscopic surgery was performed or not,the included subjects were divided into two groups,with 48 cases in group A for the surgical treatment and 41 cases in group B for the non-surgical treatment.According to the unilateral and bilateral onset of ovarian endometriotic cyst,each group was divided into A1,A2 and B1,B2 groups.First of all,the ovarian reserve function（AMH,AFC）was compared between group A and group B before operation.Then the basic indexes of patients in groups A1,B1,A2 and B2 were compared and analyzed:age,years of infertility,postoperative AMH,postoperative AFC,basic hormone levels（FSH,LH,E2,P）,ovulation induction indicators: Gn dosage,Gn days,daily HCG hormone levels（LH,E2,P）,number of retrieved oocytes,number of fertilized eggs and number of embryos obtained,as well as pregnancy outcome: fertilization rate,implantation rate,clinical pregnancy rate and abortion rate.To explore whether the difference between the two groups is statistically significant.Results:1.A total of 89 infertile women were included in this study,including 48 in the operation group and 41 in the non-operation group.There was no difference in ovarian reserve between the preoperative operation group and the non-operation group（P > 0.05）.The average AMH of the operation group for unilateral ovarian endometrioma after surgical operation was much lower than that of the non-operation group,and there was a statistically significantly difference（P < 0.01）,and the average years of infertility,average basal LH,average E2 in HCG days and the average number of retrieved oocytes in the operation group were lower than those in the non-operation group（P < 0.05）.The average daily LH level of HCG in the operation group was higher than that in the non-operation group（P < 0.05）.There was no statistical difference in average age,BMI,AFC,basal FSH,basal E2,average Gn dosage,average Gn days,average P in HCG days,average number of fertilization and average number of embryos between the unilateral ovarian endometrioma surgery group and the non-operation group.There was no statistical difference in fertilization rate,implantation rate,clinical pregnancy rate and miscarriage rate between the two groups（P > 0.05）.2.The average AFC of the bilateral ovarian endometrioma cyst operation group was lower than that of the non-operation group after operation,and there was a statistically significant difference（P<0.01）;The average AMH,average years of infertility,average LH in HCG days,average E2 in HCG days and the average number of retrieved oocytes,fertilization and embryos obtained in the operation group were lower than those in the non-operation group（P < 0.05）.There was no statistical difference in average age,BMI,basal FSH,basal LH,basal E2,average Gn dosage,average Gn days and average P in HCG days between unilateral ovarian endometriotic cyst operation group and non-operation group（P > 0.05）.There was no statistical difference in fertilization rate,implantation rate,clinical pregnancy rate and miscarriage rate between the two groups（P > 0.05）.Conclusion:1.The AMH and the number of eggs obtained in the unoperated patients with4-6cm unilateral ovarian endometriotic cysts were higher than those in the patients undergoing laparoscopic surgery,but there was no difference in fertilization rate,implantation rate and clinical pregnancy rate.2.The AMH,AFC,oocyte number,fertilization number and embryo number of patients with 4-6cm bilateral ovarian endometriotic cysts without operation were higher than those of patients with laparoscopic surgery,but there was no difference in fertilization rate,implantation rate and clinical pregnancy rate.In conclusion,for infertile patients with unilateral or bilateral ovarian endometriotic cysts,laparoscopic surgery can reduce ovarian reserve function to a certain extent,resulting in unsatisfactory results of ovulation induction in the later stage,but does not affect the clinical pregnancy rate.Therefore,for patients with4-6cm ovarian endometriosis cyst,we can consider not surgical treatment,but directly choose assisted reproductive pregnancy,reduce surgical trauma,save treatment time,and help patients with clinical pregnancy as soon as possible. |
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