Research question

Does adenomyosis affect IVF independent of decreased ovarian reserve, and what are the characteristics and IVF outcome of the ultra-long gonadotrophin-releasing hormone (GnRH) agonist protocol in adenomyosis?

Design

Observational cohort study of three groups of patients undergoing first cycle of IVF treatment with normal ovarian reserve: (A) 362 patients with adenomyosis using the ultra-long GnRH agonist protocol; (B) 127 patients with adenomyosis using the long GnRH agonist protocol; (C) 3471 patients with tubal infertility using the long GnRH agonist protocol.

Results

Compared with groups B and C, the number of oocytes retrieved in group A decreased, and the gonadotrophin dosage and duration in group A were higher (P < 0.001). In long GnRH agonist treatment, clinical pregnancy rate (OR 0.492, 95% CI 0.327 to 0.742, P < 0.001), implantation rate (OR 0.527, 95% CI 0.350 to 0.794, P = 0.002) and live birth rate (OR 0.442, 95% CI 0.291 to 0.673, P < 0.001) decreased and miscarriage rate (OR 3.078, 95% CI 1.593 to 5.948, P < 0.001) increased in adenomyosis patients compared with tubal infertility. For adenomyosis patients, clinical pregnancy rate (OR 1.925, 95% CI 1.137 to 3.250, P = 0.015), implantation rate (OR 1.694, 95% CI 1.006 to 2.854, P = 0.047) and live birth rate (OR 1.704, 95% CI 1.012 to 2.859, P = 0.044) increased in the ultra-long GnRH agonist treatment compared with long GnRH agonist treatments.

Conclusion

Adenomyosis could negatively affect IVF outcomes independent of ovarian reserve after long GnRH agonist protocol. Patients with adenomyosis following the ultra-long GnRH agonist protocol could have a better pregnancy outcome than those following the long GnRH agonist protocol.

中文翻译：

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长期或超长期GnRH激动剂治疗后子宫腺肌病对IVF的影响

研究问题

子宫腺肌病是否会独立于卵巢储备功能下降影响试管婴儿？超长促性腺激素释放激素 (GnRH) 激动剂方案在子宫腺肌病中的特点和试管婴儿结果是什么？

设计

卵巢储备正常的三组接受第一周期IVF治疗的患者的观察性队列研究：（A）362例使用超长GnRH激动剂方案的子宫腺肌病患者；(B) 127 名使用长 GnRH 激动剂方案的子宫腺肌病患者；(C) 3471 名使用长 GnRH 激动剂方案的输卵管不孕患者。

结果

与B组和C组相比，A组取卵数减少，促性腺激素用量和持续时间高于B组（P < 0.001）。在长期 GnRH 激动剂治疗中，临床妊娠率（OR 0.492，95% CI 0.327 至 0.742，P < 0.001）、着床率（OR 0.527，95% CI 0.350 至 0.794，P  = 0.002）和活产率（42OR与输卵管不孕症相比，子宫腺肌病患者的95% CI 0.291 至 0.673，P < 0.001）降低，流产率（OR 3.078，95% CI 1.593 至 5.948，P < 0.001）增加。对于子宫腺肌症患者，临床妊娠率（OR 1.925, 95% CI 1.137 to 3.250, P  = 0.015）、种植率（OR 1.694, 95% CI 1.006 to 2.854, 与 长 GnRH 激动剂治疗相比，超长 GnRH 激动剂治疗的P = 0.047）和活产率（OR 1.704，95% CI 1.012 至 2.859，P = 0.044）增加。

结论

在长期 GnRH 激动剂方案后，子宫腺肌病可能会对 IVF 结果产生负面影响，而与卵巢储备无关。接受超长 GnRH 激动剂方案的子宫腺肌病患者的妊娠结局可能比接受长 GnRH 激动剂方案的患者更好。