Effects Of Uterine Adenomyosis And Endometriomas On Clinical Outcomes Of Infertility Patients Treated With In Vitro Fertilization-embryo Transfer

Uterine adenomyosis (UA) is a activity of endometrial glands and stroma are present in the myometrium, along with the surrounding muscle layer of cells of compensatory hypertrophy and hyperplasia.Happens in 30 to 50 years old multipara. Reportedly incidence of UA disease in women of childbearing age is about 10%, and the incidence of UA disease in patients with infertility, various research reports are not uniform,from 6.9% to 34.3%.Endometriosis is a activity of endometrial tissue (including the glands and stroma) appear outside of the endometrium(EMS).Ectopic endometrium may infringe any part of the body, ovaries and palace sacral ligament are the most common, followed by the uterus, rectum womb pouch, peritoneal dirty layer, etc,called the pelvic endometriosis.Incidence of EMS disease in women of childbearing age is about 10%, and 20% to 40% of which may involve in ovarian,namely endometrioma,and the incidence of infertility in EMS patients is as high as 30%to50%.EMS and UA might have different pathological physiological basis, but both caused by ectopic endometrium, treated with similar way, what is more,the two kinds of disease are often merge,so many scholars still firmly believe a intimate relationship between the two diseases.This study was to explore the effects of UA and EMS on clinical outcomes of infertility patients treated with in vitro fertilization- embryo transfer(IVE-ET).Compared with the tubal infertility patients through a retrospective study,we analyzed the possible effects and explored the possible influencing factors of UA on the clinical outcomes after IVF-ET,so as to guide UA patients with normal ovarian function choose appropriate methods of assisted reproductive technology,make their holding baby home dream come true.By comparing ovarian reserve,ovarian reactivity and clinical outcomes after IVF-ET in patients with different EMA,to guide the EMA infertility patients choose an appropriate time and right way to improve the outcomes of IVF.Part 1:Effects of uterine adenomyosis on clinical outcomes of infertility patients treated with in vitro fertilization-embryo transfer(IVF-ET)[Objective]The aim of this study was to analyze the possible effects and explore the possible influencing factors of UA on the clinical outcomes after IVF-ET,then guide UA patients with normal ovarian function choose appropriate methods of assisted reproductive technology,make their holding baby home dream come true.[Materials & Methods]1、Our study reviewed the medical records of women followed by IVF treatment at Center for Reproductive Medicine of Obstetrics and Gynecology Department of Nanfang Hospital between January 2008 and April 2013.Define UA patients as study group,tubal factor infertility patients as control group.Transvaginal ultrasound audio-visual performance fulfilled for 2 or more of the following criteria(1) diffuse heterogeneous echoes in myometrium.(2)increased uterus,spherical or a class of spherical.(3)strong or weak light echos with unclear boundary in myometrium,we defined as uterine adynomyosis(UA),with or without any other echos.2、Inclusion criteria:(1) the first three IVF treatment cycles; (2) UA complicated by mild or moderate EMS;(3) With GnRHa long protocol or GnRH antagonist protocol; (4) age<42 years at the time of ovarian stimulation.Exclusion criteria:(1) polycystic ovary syndrome(PCOS); (2) UA complicated by fibroid or excision of UA/fibroid;(3)UA complicated by EMA or excision of EMA; (4) Male factors.3、We choose the controlled ovarian stimulation (COS)、luteal support and judge the clinical outcomes according to the usual of our center,fertilize according to sperm.4、The statistical analysis was performed with the Statistical Package for Social Science(SPSS,version 13.0 for Windows).Independent t test was used for mean comparison,chi-square test was used for rate comparison.P<.05 was considered statistically significant.[Results]1、There is no statistical difference in years of infertility,BMI,bE2,FSH/LH, fertilization method between the two groups of patients(P>0.05), while age,b-FSH, AFC, total Gn dose,No.of oocytes retrieved,No.of embryos transfered were statistically significant (P< 0.05),after adjust to age,there is no statistical difference.The clinical pregnancy rate,live birth rate decreased significantly in the study group(38.5%VS 55.7%,P=0.049;23.5%VS 38.2%,P=0.043),and early abortion rate increased significantly(35.0%VS 9.6%,P=0.010).2、There is no statistical difference in age,BMI,total Gn days,No.of follicle≥14 mmon HCG day,No.of oocytes retrieved,No.of embryos transfered and endometrial on the day of embryos transfere between the two different protocols in adenomyosis patients(P>0.05).The b-FSH and total Gn dose were significantly higher in the GnRH-agonist protocols(P< 0.05),but AFC was significantly lower,and high quality embryo rate of transplant was lower(44.8%VS 72.6%).For patients with adenomyosis,GnRH-antagonist cycles tended to decrease clinical pregnancy rate and increase abortion rate(25.0% vs 42.5%,P=0.330; 66.7% vs 29.4%, P=0.270),and significantly decrease live birth rate (0% vs 30.8%, P=0.025),compared with GnRH-agonist cycles.[Conclusions]1、Uterine adenomyosis decreases clinical pregnancy rate and birth rate,and increases abortion rate significantly in patients with IVF-ET.2、GnRH-antagonist cycles have adverse effects on the outcomes of adenomyosis.Part 2:Effects of endometriomas on clinical outcomes of infertility patients treated with in vitro fertilization-embryo transfer(IVF/ICSI-ET)[Objective]The aim of this study was to compare ovarian reserve,ovarian reactivity and clinical outcomes after IVF-ET in patients with different types and different processing methods of EMA,then guide the EMA infertility patients choose an appropriate time and right way to improve the outcomes of IVF.[Materials & Methods]1、Our study reviewed the medical records of women with endometriosis followed by IVF treatment at Center for Reproductive Medicine of Obstetrics and Gynecology Department of Nanfang Hospital between January 2004 and September 2012.According to the types of endometriosis,patients are divided into 3 groups:group A for postoperative patients with pelvic endometriosis,as the control group;Group B for unilateral endometriosis cyst(puncture or removal of endometriosis cysts),including patients with pelvic endometriosis;Group C for bilateral ovarian endometriosis cyst (puncture or removal of endometriosis cysts),including patients with pelvic endometriosis.2、Inclusion criteria:(1) patients with endometriosis after surgery or pathological biopsy diagnosis; (2) age≤42 years at the time of ovarian stimulation;(3) without any other disease besides endometriosis including polycystic ovary syndrome(PCOS).Exclusion criteria:(1)has a history of tubal surgery or other than endometriosis cyst surgery;(2)cycles cancelled due to high or low reaction.3、We choose the controlled ovarian hyperstimulation(COH)、luteal support and judge the clinical outcomes according to the usual of our center,fertilize according to sperm.4、The statistical analysis was performed with the Statistical Package for Social Science(SPSS,version 13.0 for Windows). One-way analysis of variance (One-Way ANOVA)test was used for mean comparison,(R *C) chi-square test was used for rate comparison.P<.05 was considered statistically significant.[Results]1、There is no statistical difference in age,BMI, bE2, FSH/LH, fertilization method between the three groups of patients(P>0.05), while AFC, b-FSH, stimulate ovulation scheme were statistically significant (P< 0.05).AFC in pelvic endometriosis patients was lower than unilateral and bilateral ovarian cysts patients,b-FSH in patients with bilateral ovarian cystwith is significantly higher than the other two groups, and the proportion of GnRHa long-protocol was significantly lower than the other two groups.2、There is statistically significant in total Gn dose,N0.of follicle≥ 14 mm at the day of HCG administration and NO.of oocyte retrieved(P< 0.05).The total Gn dose of endometrioma patients was significantly more than the control group patients, and bilateral ovarian cysts patients was significantly more than unilateral ovarian cysts patients;NO.of follicle≥ 14 mm at the day of HCG administration and NO.of oocyte retrieved in bilateral ovarian cysts patients was significantly lower than other two groups.3、There is no statistical difference in thickness of endometria on ET day,No.of embryo transfered and clinical pregnancy rate,ongoing pregnancy rate,live birth rate between the three groups.While there is a downtrend of cumulative delivery rate in unilateral ovarian cysts patients compared with other two groups.[Conclusions]1、Ovarian reserve may significantly reduced in endometrioma patients compared with pelvic endometrosis patients.And compared with unilateral ovarian cysts patients,the ovarian reserve in bilateral ovarian endometrosis cyst may reduce even more.2、Compared with pelvic endometriosis, bilateral ovarian endometriosis cysts may significantly reduce ovarian reactivity,while unilateral ovarian endometriosis cysts had litter adverse effect on ovarian reactivity.3、Compared with pelvic endometriosis and unilateral ovarian endometriosis cysts patients, bilateral ovarian endometriosis cysts may reduce cumulative delivery rate.