Analysis Of Postoperative Pregnancy Related Factors In Patients With Ovarian Endometriotic Cyst

ObJectiveThis study aims to provide a theory for fertility guidance in patients with ovarian endometriotic cysts and infertility,by analyzing the factors affecting pregnancy and the pregnancy outcome in patients with endometriosis and infertility after laparoscopic conservative surgery.Materials and MethodsRetrospective analysis of gynecological laparoscopic conservative surgery at the Third Affiliated Hospital of Zhengzhou University from June 2015 to June 2017,according to the following-up conditions and complete data,170 cases of ovarian endometriosis cyst were included.According to the postoperative pregnancy condition,they were divided into two groups(pregnancy group and non-pregnant group),55 cases of postoperative pregnancy,115 cases of non-pregnancy,the following clinical data were collected,such as medical history data:age during operation,age of menarche,menstrual days,symptoms of dysmenorrhea,number of abortions,infertility years,infertility type,previous gynecological inflammation history,previous history of surgery(Had a history of laparoscopic fertility preservation surgery in patients with ovarian endometriosis cysts);preoperative laboratory test indicators: CA125,sex hormones six,anti-Muller Tube hormone(AMH);intraoperative data: endometriosis fertility index(EFI),r-AFS stage,ovarian cyst lateral,ovarian cyst diameter,uterine rectal depression closed condition,combined with other lesions in other parts of the pelvic cavity,surgeon grade,postoperative medication:postoperative use of gonadotropin releasing hormoneagonists(GnRH-a)and ovulation-promoting drugs after operation,post-operative(or discontinuation of GnRH-a)pregnancy time,pregnancy mode and pregnancy outcome,etc,and analysis of r-AFS,EFI,postoperative GnRH-a effect on pregnancy outcome.Spss 21.0 software was used for statistical analysis,univariate analysis and multi-factor logistic regression analysis were used to analyze the factors affecting pregnancy rate and pregnancy outcome in patients with ovarian endometriosis.Result1.This study showed that in patients with ovarian endometriosis cysts,55 patients with natural pregnancy within 1 to 2 years after laparoscopic preservation of functional surgery,the pregnancy rate was 32.35%(55/170).2.Postoperative(or discontinuation of GnRH-a drug)17 cases of pregnancy within 3 months,19 cases of pregnancy within 3 to 6 months,14 cases of pregnancy from 6 to 12 months,5 cases of pregnancy over 12 months,pregnancy rate respectively was 10.0 %(17/170),12.42%(19/153),10.45%(14/134),4.17%(5/120),the cumulative pregnancy rate respectively was 10.00%(17/170),21.18%(36/170),29.41%(50/170),32.35%(55/170),the pregnancy rate was the highest within 3 to 6 months after surgery,and the pregnancy rate decreased significantly after 12 months.3.The study showed that the pregnancy rate of patients with stage I to II is 40%(18/45),the pregnancy rate for patients with stage III is 35.71%(20/56),and the pregnancy rate for patients with stage IV is 24.64%(17/69).4.The study showed that the EFI score was ≤ 4 points,the pregnancy rate was 1 1.43%(4/35),the EFI score was 5-8 points,the pregnancy rate was 34.78%(40/115),and the EFI score was 9-10 points,the pregnancy rate is 55%(11/20).5.Univariate analysis showed: age during operation,previous history of gynecological inflammation,previous history of surgery,ovarian cysts,EFI score,uterine rectal depression closed condition,and the use of ovulation-promoting drugs after operation in the pregnant and non-pregnant groups,the difference was statistically significant(P<0.05),and the age of menarche,menstrual days,preoperative dysmenorrhea,number of abortions,infertility years,type of infertility,preoperative CA125 value,r-AFS stage,ovarian cyst diameter,the combination of internal lesions in other parts of the pelvic cavity,the level of the surgeon,and the postoperative GnRH-a drug were not significantly different between the two groups(P>0.05).6.Multivariate logistic regression analysis showed that high EFI score was protective factors for postoperative pregnancy;age > 35 years,previous history of gynecological inflammation,previous history of surgery,and bilateral ovarian endometriosis cysts were risk factors for postoperative pregnancy.7.This study showed no significant difference in preoperative luteinizing hormone(LH),follicle stimulating hormone(FSH),estradiol(E2),testosterone(T)levels and AMH between the pregnant and non-pregnant groups(P>0.05).The levels of progesterone(P)and prolactin(PRL)were statistically significant(P<0.05).8.There were no significant differences in pregnancy outcomes between different r-AFS staging,different EFI scores,and whether GnRH-a was used after surgery(P>0.05).conclusion1.Higher EFI score is a protective factor affecting postoperative pregnancy;the higher the EFI score,the higher the pregnancy rate.2.Age > 35 years old,previous history of gynecological inflammation,previous history of surgery,bilateral ovarian endometriosis cysts are risk factors for postoperative pregnancy in patients with ovarian endometriosis;usually should minimize the incidence of gynecological inflammation.For patients with recurrent and bilateral ovarian endometriosis,if surgery is required,careful consideration is required.3.Ovarian endometriosis cysts combined with infertility,postoperative pregnancy rate is affected by preoperative endocrine.If there is endocrine disorder before surgery,it should be actively treated and corrected endocrine disorders to improve pregnancy rate.