Effects Of Various Treatments On Pregnancy Rate Of The Infertile Patients Caused By Endometriosis

Objective:To evaluate the pregnancy rate of various follow-up treatment for the infertility pa-tients with endometriosis after laparoscopic operation.Methods:Retrospective analysis of816patients with infertility which were diagnosed in thesecond hospital of Jilin University and (or) the other first class and three level hospital be-tween January2008to December2011. The patients were divided into the study group（The EMs group） and the control group（The unEMs group）according to differentpathogeny;The EMs with infertility group of656cases and The other infertility patientswith ovarian benign tumor or pelvic inflammatory sequelae，this group was160cases(including80cases of benign ovarian tumors,80cases of pelvic inflammatory sequelae).All the patients were first treated by laparoscopic operation. The EMs patients were guidedto the follow-up treatment after laparoscopic operation according to r-AFS1985staging,Those stageⅠof EMs patients were suggested to apply2cycle of GnRH-a drug after oper-ation. Those stage Ⅱ～Ⅳ EMs patients were recommended to apply6cycles of GnRH-adrug after laparoscopic operation. The practical application of GnRH-a were recorded inthe meanwhile. After two years of follow-up which was calculated since the recovery ofpatients’ menstruation. This essay had a retrospective analysis about the medication ofthose with assisted reproductive technology after laparoscopic operation through askingabout patients if ever used drugs before assisted reproductive technology treatment andkeep an account of their using cycle. This essay also analyse the patients’ menstrual re-covery time to those who applied different period of GnRH-a drug after operation, the dis-tance between menstrual recovery and natural pregnancy, the successful pregnancy rateafter associated with assisted reproductive technology, recurrent rate of abdominal painsymptom and pregnancy complications for those who had a successful pregnancy. The ab- dominal pain recurrent rate after operation was judged via VAS (visual analogue scale)system. This study using SPSS20.0for statistical data analysis and test, P<0.05meansthere was statistical significant differences.Results：1. The natural pregnant rate in different stage of EMs had statistically difference by χ2test for most of EMs patients, most of the P values was less than0.05. Through regressionanalysis, the regression coefficient was minus0.12. The stage of EMs and the naturalpregnancy rate had negatively correlated. The successful rate of the assisted reproductivetechnology had statistically difference between stageⅠand Ⅲ EMs patients or stageⅠand ⅣEMs patients by χ2test, the P values was less than0.05. Through the regressionanalysis, the regression coefficient was minus0.13,95%of the regression coefficient in-terval(-0.28,0.11), this span include0. It was unsure that the diverse stage of EMs and thesuccess rate of assisted reproductive technology has negative correlation.2. In patients with stageⅠEMs, there was a comparison in the natural pregnancy ratebetween using1or2cycle of GnRH-a treatment after operation respectively and direct at-tempt to pregnancy after the operation. There was no statistically difference by χ2test. Theχ2test value was0.68, and the P value was0.71. The natural pregnant rate of the threemethods has no significant difference. Those stage Ⅰ EMs patients who took1or2cy-cles of GnRH-a or without using GnRH-a drug after operation had no significant differencein respec of successful pregnant rate with apply assisted reproductive technology.The Pvalue was0.92.3. There was a comparison of the natural pregnancy rate between stage with no appli-cation of GnRH-a treatment and1to6cycles of GnRH-a treatment inⅡto Ⅲ EMs pa-tients. There was significant difference for diverse using cycle of GnRH-a treatment, the Pvalue was less than0.05. And the cumulative pregnant rate between1to3cycles ofGnRH-a treatment and the application of4~6cycle GnRH-a drug in stage II EMS patientshad statistically difference by χ2test. The P value was0.00. And there also had statisticallydifference in patients with stage Ⅲ EMS in the above comparison. The P value was0.06*10-1. However for those stage Ⅱto Ⅲ EMs patients, there was no significant dif- ferences in aspect of natural pregnant rate with no application of GnRH-a and treated withGnRH-a1～3cycles, Through regression analysis, the different periods of apply GnRH-adrugs in patients with stage Ⅱ and Ⅲ shows positivecorrelation.to patients’ naturalpregnant rate.4. The statistical results showed that there were differences in the successful rate ofthe assisted reproductive technology between diverse applicattion of GnRH-a drugs andwithout application of GnRH-a drugs. but using the assisted reproductive technology di-rectly for stage Ⅱ~Ⅲ EMS patients, The P values were less than0.05. But the successrate of the assisted reproductive has no statistical significant difference only in no applica-tion of GnRH-a group and13cycle group. This situation had the same performance as thenatural pregnancy rate of the two stages described above. The relationship between the ap-ply of different stage of GnRH-a drugs and the successful rate of assisted reproductivetechniques had positive correlation in regression analysis, the regression coefficient was0.14,95%of confidence interval was (0.09,0.17).5. The pregnant rate of diverse period of using GnRH-a drug from0~6period werecompared in the stage Ⅳ EMS patients. The pregnant rate showed no difference in theperiod of using GnRH-a drug, The P value was more than0.05. There were no significantdifference in the pregnancy rate to those without GnRH-a drug treatment, the applicationof1~3cycles’ or4~6cycles GnRH-a drug. The P value was more than0.05. For patientswith stage Ⅳ EMs, whatever use of GnRH-a drug or how many cycles can not improvethe successful rate of assisted reproductive technology. The χ2test value was0.15, The Pvalue was0.93.6. During the2years’ follow-up (since the recovery of the menstruation), There was aanalysis if the recurrence of symptom(pain) were difference for the application of GnRH-adrug, The statistical results showed that, for the same stage of EMs, the rate of recurrenceof abdominal pain were different in diverse using period of GnRH-a drug,The P valueswas less than0.05. And with the more apply of GnRH-a cycle after the operation, the lesspain occur.7. No matter which treatment was taken,98.7%of the patients were pregnant within 45weeks after treatment (1year). Regardless of whether apply GnRH-a with any cycles,the abortion rate of early pregnancy has no significant difference.8. Through laparoscopic surgery, There was no statistical difference in aspect of natu-ral pregnancy rate between the stage Ⅰ EMs of infertility patients and PID sequel pa-tients, the P values was0.78. But there had significant statistical difference in naturalpregnancy rate between the stageⅠEMs of infertility patients and pelvic inflammatory se-quelae patients, the P value was0.00.Conclusion:1. With the EMS stage increased, the natural pregnancy rate decreased.2. The stageⅠendometriosis patients with fertility requirements can attempt to directnatural conceive after the laparoscopic operation, if the patients can not achieve their goal,they may choose assisted reproductive technology to help pregnancy.3. It is suggested that to those stageⅡ~Ⅲ endometriosis patients with fertility re-quirements can at least apply4cycles of GnRH-a drug, If one year after attempt to preg-nancy, the patient had not pregnancy ever,the assisted reproductive technology can help toachieve their purpose.4. For the stage Ⅳ EMS patients who had fertility requirements should apply directassisted reproductive technology to improve the pregnancy rate.5. For the above stage Ⅱ EMS patients without fertility requirements can use longcourse of GnRH-a treatment, this treatment can help to remiss the EMs symptom and re-duce recurrence of the disease.6. Both for the patients who had successful natural pregnancy or had successful adop-tion of assisted reproductive technology, no matter which stage of endometriosis, theGnRH-a can not reduce the rate of early abortion rate.