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主题:[转帖]子宫内膜异位症III/IV期患者术后接受体外受精/胞浆内单精子注射的时间间隔对于结果的影响

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[转帖]子宫内膜异位症III/IV期患者术后接受体外受精/胞浆内单精子注射的时间间隔对于结果的影响  发帖心情 Post By:2011-6-22 15:19:00

Effect of interval after surgery on in vitro fertilization/
intracytoplasmic sperm injection outcomes in patients
with stage III/IV endometriosis
子宫内膜异位症III/IV期患者术后接受体外受精/胞浆内单精子注射的时间间隔对于结果的影响

Keywords: endometriosis; infertility; fertilization in vitro; surgery
关键词:子宫内膜异位,不孕,体外受精,外科手术

Background For patients with severe endometriosis, the spontaneous pregnancy rates have been reported to be near 0 due to extreme distortion of normal pelvic anatomy. Surgery is one of the treatment options; however, if patients failed to conceive after surgery, in vitro fertilization (IVF) is effective. The objective of this retrospective study was to determine the clinical characteristics of IVF/ intracytoplasmic sperm injection (ICSI) in patients with stage III/IV endometriosis, and to determine the impact of the interval from surgery to IVF/ICSI on outcome.
背景:子宫内膜异位患者由于其极度扭曲的盆腔解剖结构,在所知的报道中其自然怀孕的概率几乎0。外科手术是一种治疗的选择,因此患者在外科手术失去效用后,体外受精还是有效的。这篇文章,只要是回顾体外受精/浆内单精子注射对子宫内膜异位III/IV期患者的效果,并了解影响体外受精/浆内单精子注射的时间间隔。

Methods One hundred and sixty patients who were diagnosed with stage III/IV endometriosis underwent IVF /ICSI cycles between February 2004 and June 2009 were enrolled. The mean interval from surgery to IVF, number of oocytes retrieved, fertilization rate, implantation rate, embryos transferred, and good embryos transferred were compared between two age groups (≤35 years and > 35 years).
方法:在2004年2月到2009年6月登记的160名子宫内膜异位III/IV期并接受过体外受精/浆内单精子注射的患者。体外受精的间隔时间,取出的卵母细胞数量,受孕率,着床率,胚胎移植,两个年龄段良好胚胎移植比较(≤35岁和≥35岁。)

Results The mean interval from surgery to IVF was (37.9±28.9) months for the group ≤ 35 years of age and (57.6±39.7) months for the group >35 years of age. Twenty-five IVF/ICSI cycles (12.8%) were performed during the first year after surgery, and 34.9% IVF/ICSI cycles were performed 2 years after surgery. No significant differences existed between the two groups with respect to the fertilization rate, implantation rate, number of embryos transferred, number of good embryos, clinical pregnancy rates, live birth rates, and cumulative clinical pregnancy rates (P >0.05). The probability of cumulative clinical pregnancies was 75%, 50%, and 25% ((29.0±4.8), (61.0±7.6), and (120.0±16.9) months after surgery, respectively).
结果:≤35岁组的体外受精间隔期间是37.9±28.9个月,≥35岁组的体外受精间隔期间是57.6±39.7个月。25个体外受精/浆内单精子注射周期(12.8%)会在手术后第一年进行,34.9%的体外受精/浆内单精子注射周期会在手术后第二年进行。在受孕率,着床率,胚胎移植数量,良好胚胎的数量,临床受孕率,出生率,累计临床妊娠率(P>0.05)方面不存在显著差异。在术后,累计临床妊娠率分别为75%,50%,和25%(29.0±4.8),(61.0±7.6),(120.0±16.9)个月。

Conclusions For infertile patients with stage III/IV endometriosis, the optimal time to conceive by IVF/ICSI is <2 years after surgery; nevertheless, most of the patients took a longer time to conceive
结论:对于那些患有子宫内膜异位III/IV期的不孕患者,最佳的体外受精/浆内单精子注射时间是在术后两年内受孕,然后,很多患者却选择在更久的时间后受孕。

endometriosis is one of the most challenging diseases for gynecologists who treat infertile women. The incidence of endometriosis in women with subfertility ranges from 20%–30%. For patients with severe endometriosis, the spontaneous pregnancy rates have been reported to be near 0% due to distortion of normal pelvic anatomy.1 Thus, surgery is one of the options to improve fecundity.2 If patients fail to conceive after surgery, in vitro fertilization (IVF) is an effective treatment option.1 In patients with endometriosis-associated infertility, surgery followed by IVF–ET is more effective than surgery alone.3 In practice, the interval from surgery to IVF varies greatly, and is determined by various factors, such as the
expectation for children, the economic burden and tubal patent condition. Whether or not the interval of time after surgery will influence the success rate of IVF is of clinical importance. In this retrospective study, we determined whether or not the interval from surgery to IVF had an influence on IVF outcome of infertile patients with stage III/IV endometriosis, and discuss the role of the physician in counseling patients after surgery.
对治疗不孕妇女的妇科医生来说,子宫内膜异位是最具挑战性(最复杂的)病症之一。子宫内膜异位造成妇女生育能力低下的概率很高,大约在20%~30%之间。子宫内膜异位患者由于盆腔骨骼及其扭曲,在所知的报道中其自然受孕率接近0%。因此手术是改变生育能力的一种选择。如果手术失败,体外受精是另一种有效的治疗方式。子宫内膜性不孕患者来说,术后进行体外受精和胚胎移植比单一手术治疗更有效。在实践中,由于各种因素的影响,从手术到体外受精的间隔比较大,例如对孩子的期望,经济负担和输卵管先天条件。术后间隔时间的长短将会影响体外受精成功率,这具有非常重要的临床意义。在这次回顾研究中,我们发现,术后和体外受精之间的间隔对子宫内膜异位III/IV期不孕患者体外受精结果又影响,并以医生的角色讨论病人术后的指导。


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  发帖心情 Post By:2011-6-22 15:19:50

METHODS
Patients and grouping
(病人和组别)
One hundred sixty infertility patients with stage III/IV endometriosis who had undergone laparoscopic or transabdominal cystectomy between February 2004 and June 2009 at the Reproductive Medical Center of Peking University Third Hospital prior to IVF/ intracytoplasmic sperm injection (ICSI) were retrospectively identified. The severity of endometriosis was determined based on the American Fertility Society Classification (1985).4 Exclusion criteria included significant male factors, or women with polycystic ovarian syndrome (PCOS),hydrosalpinges, and uterine fibroids. Among the 160 patients, 68 underwent frozen embryo transfer (FET) treatment cycles. All subjects were divided into two age groups (≤ 35 years and >35 years). There were 114 women in the younger age group and 46 women in the older age group. This study was approved by the Ethics Committee of Peking University Third Hospital.
在2004年2月到2009年6月间,166名子宫内膜异位III/IV期不孕并进行过腹腔镜或者腹部膀胱切除术治疗的患者,并且这些患者被确认已经在北大第三医院生殖中心进行过体外受精/浆内单精子注射治疗。子宫内膜异位症状是严格按照美国生育学会分类(1985)。排除标准包括重要的男性因素,患有多囊卵巢综合症、输卵管积水(hydrosalpinges)、子宫纤维瘤的女性。在这166名患者中,有68人进行过冰冻胚胎转移治疗周期。所有的受试者被分为两个组(≥35岁,≤35岁)。114名在年岁小的一组,46人在年岁大的一组。本研究由北京大学第三医院伦理委员会批准。


All women received a short down-regulation ovarian stimulation protocol. In brief, GnRH-α was administered from day 2 of menstruation (diphereline 0.1 mg; Beaufour,
Ipsen, France). Ovarian stimulation started on day 3 with 225 IU daily of rFSH (Gonal-F, 75IU; Serono, Italy).Serial ultrasound scans were performed during ovarian stimulation. When at least 2 follicles reached a maximum diameter of 17–18 mm, 10 000 IU of human chorionic gonadotropin (hCG) (Profasi, 5000 IU per ampoule;
Serono) was administered subcutaneously. Ultrasoundguided transvaginal oocyte retrieval was performed 35–36 hours later. A normal fertilization rate was defined as the number of embryos with two pronuclei 24 hours after fertilization divided by the total number of all oocytes (IVF cycles) or MII oocytes (ICSI cycles). Embryos were classified according to the proposed criteria;5 specifically, embryos with < 20% overall fragmentation (grade 1 or 2), together with > 6 blastomeres on day 3 were considered as good embryos. Embryo transfer was performed on day 3.
Chemical pregnancies were indicated by an increased serum β-hCG concentration 14 days after embryo transfer, and clinical pregnancies were confirmed by sonographic
demonstration of a gestational sac 30 days after embryo transfer. The implantation rate was defined as the number of gestational sacs divided by the total number of
transferred embryos. The luteal phase was supported with the daily intramuscular administration of 60 mg of progesterone(Shanghai General Pharmaceutical Company Ltd., China), beginning on the day after oocyte retrieval. Patient follow-up was carried out either by clinical appointments or by telephone interview.
所有女性都会收到一份关于短时刺激卵巢降调节的协议。简单的说就是从月经周期的第二天起,使用GnRH-α(达菲林0.1mg,法国博福益普生公司)【注:当给予大剂量的外源性GnRH后,垂体细胞的GnRH受体丢失,出现降调节(down-regulation),这时促性腺激素的水平也减少,这就是临床上用大剂量GnRH激动剂抑制垂体一性腺轴的作用机制。】在卵巢刺激的第三天,每天使用225IU的rFSH,(果纳芬,75IU,雪兰诺公司,意大利),在卵巢刺激期间要进行不连续的超声扫描。当至少2个滤泡制直径最大为17~18mm时,皮下注射10000IU的人绒膜促性腺激素 (人绒膜促性腺激素,5000IU/安瓿,雪兰诺)。超声定位经阴道取卵在35~36小时之后。一般情况下,受精的定义为:胚胎的数量等于2个原核在受孕后24小时分裂除以所有卵母细胞的数量(试管婴儿周期)或者MII期卵母细胞数量(卵胞浆内单精子注射周期)。胚胎按照提出的标准分类,特别是整体分裂<20%(第1,2阶段)并且在第三天分裂球>6的被认为是良好的胚胎。胚胎移植在第三天进行。在胚胎移植后第十四天,怀孕的化学特征表现为血清β-HCG的浓度增加,在胚胎移植的第三十天,超声显示妊娠囊的存在即被确认为临床怀孕。植入率等于妊娠囊的数量除以胚胎移植的总数。黄体期每天要肌肉注射黄体酮60mg(上海医药总公司,中国),开始时间是卵母细胞取出后的第二天。通过电话访问或者门诊预约进行随访。



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  发帖心情 Post By:2011-6-22 15:20:27

Statistical analysis
统计分析
Data are expressed as the mean± standard deviation (SD) or percentage. Statistical analysis was performed with a t-test for parametric data or a χ2-test for categorical data. The crude probabilities of clinical pregnancies were calculated using Kaplan-Meier survival analysis (KMSA) which is a method of generating tables and plots of survival or hazard functions for event history data (time to event data). All statistical calculations were performed with SPSS 13.0. A P <0.05 was considered statistically significant.
数据表示为:平均值±标准偏差(SD)或者百分比。统计分心用t检测进行参数数据分析或者用X2检测进行绝对数据分析。用K-M生存分析计算临床受孕的原始概率(K-M生存分析法是一种生成的表格,描绘事件历史数据幸存或危险的函数,即时间-时间数据。所有的数据计算使用的方法是SPSS13.0.A.P<0.05,这样才具有统计意义。

 

RESULTS结果
Characteristics of patients in different groups不同组的患者特征
The clinical characteristics of patients in the two age groups at the time of IVF/ICSI are presented in Table 1. There were no significant differences between the two
age groups with respect to basal FSH (day 2), basal E2,the length of the stimulation phase, and E2 levels of hCG day. The infertility period and interval from surgery to IVF/ICSI were longer in the older group (>35 years of age) than the younger group (≤35 years of age). The total gonadotropin requirement was higher in the older age
group (Table 1). Among the 160 patients, bilateral tubal occlusion was demonstrated in 41 patients (25.6%); bilateral or unilateral tubal patency existed in 90 (56.3%) and 29 patients (18.1%), respectively. Intrauterine insemination was attempted in 17 patients (14.3%) with at least 1 patent tube after surgery. Endometriomas recurred in 88 patients (40.4%) prior to IVF/ICSI. A second laparoscopic or transabdominal cystectomy was performed in 19 patients, and transvaginal ultrasoundguided aspiration of ovarian endometriomas was performed in 10 patients prior to IVF/ICSI; another 10 patients underwent aspiration of ovarian endometriomas during oocyte retrieval (Table 1).
两个年龄组的患者在进行体外受精/卵胞浆内单精子注射时临床的不同特征见表1。在基本的FSH(第2天),基础的E2,刺激阶段的长度,使用人绒膜促性腺激素期间E2的水平的方面,两个年龄组没有显著差异。在年长组(>35岁)不孕期间和术后到体外受精/卵胞浆内单精子注射间隔时间比年轻组(≤35岁)要长。在年长组(>35岁)总的促性腺激素需求比较高(见表1)。在这160名患者中有41人患有双边输卵管阻塞(占25.6%),双边或者单边输卵管开放的分别有90人(56.3%)和29人(18.1%)。有17人(14.3%)尝试通过子宫内受精,至少有1人是术后开放输卵管。在进行体外受精/卵胞浆内单精子注射之前,有88人(40.4%)再次发生子宫内膜异位的情况。其中有19人进行第二次腹腔镜或腹腔膀胱切除术治疗,在进行IVF/ICSI之前,有10人经阴道超声定位吸入子宫内膜异位的卵巢,另外10人采用在取卵细胞期间吸入子宫内膜异位的卵巢。(见表1)



 


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  发帖心情 Post By:2011-6-22 15:21:18

Laboratory and clinical outcomes(实验和临床结果)
Among the 160 patients, 218 stimulation cycles resulted in 196 fresh embryo transfer cycles and 22 cancelled cycles (6 cycles with no oocytes retrieved, 10 cycles with
no embryos transferred, and 6 cycles were cancelled to prevent the ovarian hyper-stimulation syndrome). Only 28 cycles (12.8%) were performed in the first year after surgery; 76 cycles (34.9%) were performed 2 years after surgery Women in the older group (>35 years) had a higher hypo-response rate than the younger group (≤35 years). The number of oocytes retrieved was significantly higher in the younger group (8.9±5.8) than the older group (6.9±4.4). No significant differences were found between the two groups with respect to the fertilization rate, implantation rate, number of embryos transferred, or the number of good embryos. The clinical pregnancy and live birth rates were not statistically different between the two
groups. The cumulative clinical pregnancy rate was 44.1% in both groups (Table 2).
在这160名患者中,218次周期刺激导致196次新的胚胎移植周期和22撤消周期(其中6次周期没有取卵母细胞,10次没有进行胚胎移植,6次取消是为了防止卵巢过度刺激综合症的发生)。只有28个周期(12.8%)在术后第一年进行,76个周期是发生在手术2年以后。年长组女性(>35岁)弱应答比年轻组(≤35岁)要高。相对于年长组(>35岁)(6.9±4.4),取回卵母细胞的数量对年轻组(≤35岁)(8.9±5.8)来说意义更加重大。在受孕率,植入率,胚胎移植数量,和良好胚胎数量上,两组没有显著不同。两组的累积临床受孕率均为44.1%。见表2。


Relationship between IVF/ICSI outcomes and the
interval from surgery to IVF/ICSI IVF/ICSI结果和术后到IVF/ICSI间隔之间的关系
The overall probability of cumulative clinical pregnancies after surgery was calculated by Kaplan–Meier survival analysis (Figure). A longer interval between surgery and IVF/ICSI was correlated with a lower probability of cumulative clinical pregnancy after surgery. The probability of cumulative clinical pregnancies was 75%,
50%, and 25% ((29.0±4.8), (61.0±7.6), and (120.0±16.9) months after surgery, respectively).
术后累计的临床受孕率由K-M生存分析法估算得出。沿着术后和IVF/ICSI之间间隔,术后临床累计受孕率比较低。临床累计受孕率分别为:75%,50%,25%(分别是术后(29.0±4.8)个月, (61.0±7.6)个月, and (120.0±16.9)个月 )


DISCUSSION讨论
Fecundity of patients with stage III/IV endometriosis
after surgery子宫内膜异位III/IV患者在术后的生育能力
Stage III/IV endometriosis has significant effects on fertility because of marked anatomic distortion and adhesions. It has been reported that the spontaneous pregnancy rate is as low as near 0% with severe distortion of pelvic anatomy.6-10 Surgery is generally the treatment of choice to correct distorted pelvic anatomy and excise endometriomas, and can improve pregnancy rates in comparison to no treatment or medical therapy.
III/IV期子宫内膜异位对生育有着非常重要的意义,因为其形体上的扭曲和粘连标志。据报道,盆骨严重的形态扭曲使自然怀孕率几乎接近0%。手术是通常选择的治疗方式,以矫正形态上扭曲的盆骨,与没有治疗或者没有医学治疗相比,增加了怀孕率。

In women with advanced stages of endometriosis, the spontaneous pregnancy rate after laparoscopic surgery in the first 6 months (23%) has been reported to be significantly greater than in the following 6 months. This finding suggests that IVF should be proposed as soon as patients fail to conceive spontaneously and within a maximum of 1 year from the time of laparoscopic surgery。
对于患有最严重阶段子宫内膜异位的女性来说,在已知的报道中,使用腹腔镜手术治疗后的头六个月内的自然受孕率(23%)比后六个月的意义更为重大。这暗示患者在自然受孕失败后,且在腹腔镜手术治疗后一年内尽快做IVF的准备。
In the current study, the probability of cumulative clinical pregnancies after surgery was calculated with the Kaplan–Meier survival analysis based on the interval of time between surgery and attempted IVF cycles. The probability of cumulative clinical pregnancies was 75%, 50%, and 25% from surgery, respectively. Thus, the ideal interval in which to conceive by IVF/ICSI is <2 years after surgery. Considering the low response rate to controlled ovarian hyperstimulation was significantly higher in patients >35 years of age, patients should attempt IVF/ICSI
as early as possible. Given the fact that the current study was retrospective, it will be interesting to compare the results of a prospective, randomized, control study to follow the fecundity of patients after surgery to better understand the exact effects of the interval of time after surgery and patient age with IVF outcome.
在现阶段的研究中,利用K-M生存分析法估算出来的术后累计临床怀孕率是基于手术和尝试IVF周期之间的间隔时间。从手术,临床累计怀孕率分别为75%, 50%, 和25%。因此,理想的利用IVF/ICSI怀孕的时间应该是术后两年内。就低回应率来控制卵巢过度刺激对>35岁的患者来说,具有非常重大的意义,患者需要尽可能早的尝试IVF/ICSI.给出的事实证据是现阶段研究的回顾,与不确定随机相比其结果,控制研究那些术后怀孕的患者能更了解术后时间间隔,患者的年龄和IVF之间更加精确的影响。



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  发帖心情 Post By:2011-6-22 15:22:19

Present status of IVF/ICSI for infertile patients with
stage III/IV endometriosis IVF/ICSIZ现在的状况之于子宫内膜异位III/IV期不孕患者
Even though IVF is currently considered an effective treatment in women with endometriosis, the percentage of women who undergo IVF after surgery is not high. A recent study from Italy reported that only 33% patients
attempted IVF 3 years after surgery for endometriosis, and as high as 51% of patients never attempted IVF, even where the IVF treatment cycles were entirely supported
by the public health system. One of the reasons proposed for this low rate is that gynecologists are usually not engaged in assisted reproductive technology. Therefore, patients may fail to receive the detailed counseling and adequate information regarding IVF, which prevents them from making an informed and shared decision on treatment alternatives with clinicians。
尽管IVF现在被认为是一种治疗女性子宫内膜性不孕的方法,但是在术后使用IVF治疗的女性的比例并不高。近期意大利的一个报告显示,仅有33%的患者在子宫内膜异位手术3年后尝试IVF,高大51%的患者并没有尝试IVF,尽管IVF治疗周期完全由公共医疗系统支持。提出的原因之一是低利用率,主要是由于妇科医生通常不从事辅助生殖技术。因此病人未能收到关于IVF详细的咨询和足够的信息,从而妨碍他们做一个明智的临床治疗方案。
In this study, only 12.8% of IVF/ICSI cycles were performed in the first year following surgery and 34.9% of IVF/ICSI cycles were performed 2 years after surgery for infertile women with stage III/IV endometriosis. The mean interval from surgery to IVF was (37.9±28.9) months for patients < 35 years of age, and (57.6±39.7) months for patients > 35 years of age. Most of the stage III/IV endometriosis patients’ attempted expectant management longer than they had been advised. For those patients with at least 1 patent tube, only 17 patients (14.3%) attempted intrauterine insemination prior to IVF/ICSI. These results may indicate that surgeons fail to recognize the importance of patient follow-up and fertility guidance for infertile patients with stage III/IV endometriosis.
在这个研究中,只有12.8%的IVF/ICSI周期在术后第一年内使用,34.9%的IVF/ICSI周期在子宫内膜性III/IV期不孕患者术后使用。这就意味着从手术到IVF,<35岁的患者间隔为(37.9±28.9)个月,>35岁的患者间隔为(57.6±39.7)个月。大多数子宫内膜异位III/IV期患者期待疗法多于他们被建议的。这些患者中,只要有一个开放的输卵管,仅仅17位患者(14.3%)在IVF/ICSI之前尝试子宫内受精。这些结果表明外科医生通常无法确认患者随访,对子宫内膜异位III/IV期不孕患者生育指导的重要性。


Understanding endometriosis associated with
infertility after surgery and providing fertility
Guidance 了解术后子宫内膜性不孕症,提供生育指导
For patients with stage III/IV endometriosis, the risk of ovarian deficiency after a cystectomy for an endometrioma needs to be considered.12 Both endometrioma-related injuries and surgery-mediated damage may be involved in ovarian deficiency. In fact,
bilateral disease with laparoscopic removal of endometriomas from both ovaries has a 2.4% risk of premature ovarian failure.13-15 Thus, these patients should be cognizant of the optimal time of fertility.16 In this study, despite the common concept that the fecundity of the younger group (≤35 years) should be better than that of the older group (>35 years),17 the clinical pregnancy and live birth rates showed no significant differences between the two age groups, so the diminished fecundity of younger women after surgery should not be ignored.
对于子宫内膜异位患者来说,由于子宫内膜瘤而做膀胱切除术的导致的卵巢不足的风险需要被考虑到。子宫内膜瘤相关联的和手术接到的伤害都会涉及到卵巢缺陷。事实上,腹腔镜切除双边疾病其双卵巢卵巢功能衰竭的风险有2.4%。因此这些病人应该了解生育的最佳时间。在这个研究中,尽管年轻组(≤35岁)应该比年老祖(>35岁)的生育能力更强的概念是相同的,但是临床怀孕率和婴儿出生率在这两组中没有显著的区别,因此年轻女性术后生育能力减弱不能被忽视。
At the same time, endometriosis is a recurrent and progressive disease. The recurrence rate of endometriosis has been estimated to be 21.5% at 2 years and 40~50% at 5 years.18 Young age and stage III/IV endometriosis appear to be the factors associated with the high recurrence risk for endometriosis.19 The present study showed that 40.4% of endometriomas recurred prior to IVF/ICSI in these stage III/IV patients. Thus, the time-dependent diminution of fecundity may be related to a detrimental effect of the disease on fertility. It was also reported that stage III/IV endometriosis worsens the cumulative pregnancy and live-born rates.9,20 Therefore, patients should be advised to start trying to conceive immediately after surgery.
同时,子宫内膜异位是一种会复发的,逐步恶化的疾病。子宫内膜异位症复发率估计是2年内21.7%,5年是40%~50%。年轻和子宫内膜异位III/IV期与高复发风险的子宫内膜异位症是相关联的因素。目前的研究表明,在III/IV期患者中,40.4%的子宫内膜异位症患者在做IVF/ICSI之前复发。因此,随时间减弱的生育能力可能与对生育能力有害的疾病有关。据了解,子宫内膜异位III/IV期患者会降低累计怀孕率和出生率。因此,术后,患者应该被建议立即开始尝试怀孕。
Although the decision to undergo ART is determined by personal preference and ethical consideration or economic situations of the patients, physician guidance is still very important. For patients with stage III/IV endometriosis associated with infertility, a comprehensive evaluation of fecundity should be made according to age,the basal hormonal levels of the patients, and the expectation for a baby. The advantages and disadvantages should also be fully discussed with the patient. Any decision for expectant guidance or an expedient attempt IVF should be carefully considered.
尽管决定是出于病人对ART个人喜好,伦理考虑或者经济情况,但是医生的指导仍然是很重要的。子宫内膜异位III/IV期不孕患者,生育的综合评价必须依据年龄,患者的基本荷尔蒙水平,和对孩子的期待。
In conclusion, for infertile patients with stage III/IV endometriosis, the optimal time for IVF/ICSI should be<2 years after surgery. In order to achieve a better clinical outcome, a following-up system should be established to give the patients timely guidance. Surgeons should keep in mind that the objectives of surgery are not only to remove endometriomas or alleviate symptoms, but also to
shorten the time interval to conception.
总而言之,对于子宫内膜性不孕患者来说,选择IVF/ICSI的时间必须在术后两年内。这样才能取得较好的临床效果,随访体质中,要给患者见一个时间指导。外科医生必须牢记手术的目的不仅仅是改变子宫内膜异位或者缓和其症状,更在于缩短时间间隔怀孕。



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