| Endometriosis, EMT for short, refers to the presence of functinal endometrial glands and stroma at various extrauterine sites in women. It is a common gynecologic disease which manifests a series of clinical symptoms and pathological changes. The major clinical manifestations include growing pelvic adhesion, pain, infertility, etc. Recent studies show that the incidence of EMT rises, especially for women of childbearing age, which has serious influence on women’s reproductive health. Infertility means that a couple have contraceptive sexual life more than one year but never get pregnant. It can be divided into Primary infertility and Secondary infertility according to the history of pregnancy. The incidence of infertility is7～10%in China, and about40%infertility is attributable to the women factors, in which25～35%suffered from EMT. Thus, they are highly correlated. So the term "Endometriosis-associated infertility" has been proposed by some scholars.Currently, surgery remains the major treatment for Endometriosis-associated infertility, as surgery would clear away endometriotic lesions, restore pelvic anatomy, and improve pelvic environment, and pregnancy rate will be improved as well.Revised classification of American Fertility Society partly reflects the severity of the disease and prognosis of EMT, but remains to be discussed in determination of prognosis. It is the gold standard of medical treatment after surgery, which has a positive effect on reducing the recurrence and relieving symptoms, but no consensus on patients with a fertility requirement has been arrived. Furthermore, there isn’t an explicit relationship between surgical effect and the time with infertility, the site of the cyst, etc., which needs further research.ObjectiveThe present study, through the analysis of clinical data and follow-up of EMT merger infertile patients, aims to discuss the curative effects with different treatments, find the relationship between pregnancy with infertility category, the time of infertility, r-AFS, site of the cyst, medical treatment after surgery, etc, to find the influence factors on pregnancy.Materials and Methods215patients with endometriosis and infertility who were treated by laparoscopic conservative operation in the Third affiliated Hospital of Zhengzhou University from April of2008to April of2009were selected,180of them from23years to40years old, with an average of (30.13±4.39) years, have been completed follow-up, and the follow-up rate is83.72%, follow-up lasted36months. The180patients completed follow-up were grouped by infertility category, time of infertility, r-AFS classification system and medical treatment after surgery. Ovary endometriosis were grouped in terms of site of cyst, weather or not combined with pelvic adhesion, peritoneal endometriosis, deep infiltrating endometriosis. The relationship between fertility with each factors were discussed respectively, and all factors were analyzed by multi-variate logistic regression.Results1General resultsIn all180patients,123got natural pregnancy after surgery, the overall pregnancy rate is68.33%. In the123cases of patients with pregnancy, we got102full term delivery,6spontaneous abortion,4ectopic pregnancy and4induced labour. Full-term delivery rate was90.24%. The postoperative recurrence rate was15%, the symptom remission rate was71.43%.64cases got complete pain relief among the total of94ones,4cases recurred after a remission. Another2cases who had no pain got a pain after surgery. Pain relief rate was68.09%. Paramenia of11cases were completely resolved.Postoperative pregnancy rate declined year by year, there was statistical significance among them (χ2=26.410, P<0.05). Pregnancy rate of the1st year was higher than the2nd year (P<0.05), pregnancy rate of the2nd year was higher than the3rd year (P<0.05). Patients who got pregnancy in two years postoperative were divided into four groups (a, b, c, d) every six months after surgery, there was statistical significance among them (χ2=8.104, P<0.05), but there was no statistical significance among group a, b and c (χ2=1.248, P=0.536). Further comparison shows that there were statistical significance between group a and d (χ2ad=7.601, P=0.006), b and d (χ2bd=5.675, P=0.017), but there was no statistical significance between group c and d (χ2cd=2.817, P=0.093).2Univariate analysis results of pregnancy related factors2.1The comparison of ageThe average age of the patients with pregnancy was (29.11±3.71) years, the average age of the patients without pregnancy was (32.41±4.84) years, there was statistical significance between the two(t=5.006, P=0.001).2.2Pregnancy rate in primary and secondary infertilityPregnancy rate of primary infertility group was51.72%, and83.87%in secondary infertility group, there was statistical significance between the two groups (χ2=22.732, P<0.05).2.3Pregnancy rate and duration of infertilityThe average duration of infertility of patients with pregnancy was (2.41±1.96) years, the average duration of infertility of patients without pregnancy was (3.58±3.79) years, there was no statistical significance between the two groups (t=1.263, P=0.220). All the patients were regrouped, there was no statistical significance between patients with the duration of infertility more than3years and patients with the duration of infertility less than3years (χ2=3.170, P>0.05). Patients in primary and secondary groups were divided by duration of infertility.In primary infertility group, there was statistical significance between patients with the duration of infertility more than3years and patients with the duration of infertility less than3years(χ2=5.943, P<0.05). In secondary infertility group, there was no statistical significance between patients with the duration of infertility more than3years and patients with the duration of infertility less than3years (χ2=0.001, P>0.05). There was statistical significance between primary infertility patients with the duration of infertility less than3years and secondary infertility patients with the duration of infertility less than3years (χ2=5.943, P<0.05).2.4Pregnancy rate at different stagesPregnancy rate were61.54%at stage I,78.57%at stage II,68.97%at stage III and64.10%at stage IV, there was no statistical significance among different stages(χ2=2.250, P>0.05).2.5Pregnancy rate in patients with endometrial cystThere was no statistical significance in pregnancy rate between patients with ovarian endometrial cysts only and patients with ovarian endometrial cysts combined with pelvic adhesion, peritoneal endometriosis or deep infiltrating endometriosis (χ2=0.263, P>0.05). There was no statistical significance in pregnancy rate between patients with endometrial cyst on one ovary only and patients with endometrial cyst on both side (χ2=3.086, P>0.05). There was no statistical significance in pregnancy rate between patients with endometrial cyst on left ovary only and patients with endometrial cyst on right ovary only (χ2-1.952, P>0.05).2.6Pregnancy rate and medical treatment after surgery Pregnancy rate of the medical treatment group was lower than no medical treatment group, but there was no statistical significance between the two groups (χ2=0.477,P>0.05).3Multi-variate logistic regressionPut pregnancy in3years after surgery as dependent variable, age, type of infertility, duration of infertility, stage of EMT, type of endometriosis cyst, medical treatment after sugery were selected factors, and the related factors of successful pregnancy were analyzed by multi-variate logistic regression. Age and type of infertility were the only two factors which were associated with pregnancy rate as shown by the logistic regression analysis. The pregnancy rate declined as the age increased. The possibility of pregnancy of secondary infertility was14.61times of primary infertility, while duration of infertility, stage of EMT, type of endometriosis cyst and medical treatment after sugery had no significant effect on conception.Conclusion1Surgery is an effective treatment for patients with endometriosis-associated infertility. The thoroughness of the surgery is the key to increase pregnancy rate.2The first year is the best time to pregnancy. With the time elapsed after surgery, pregnancy rate decreased significantly.3Age and type of infertility are factors associated with postoperative pregnancy rate. Medical treatment after surgery is of no use in increasing pregnancy rate. R-AFS classification, type of endometriosis cyst is of no significance in estimating prognosis.4The longer the time of patients with endometriosis-associated primary infertility, the worse the prognosis is. But all the patients with endometriosis-associated secondary infertility get good prognosis. |
PDF Full Text Request