Research question

Is implantation impaired in patients with endometriosis undergoing IVF and intracytoplasmatic sperm injection (ICSI) cycles?

Design

A retrospective matched cohort study was carried out on IVF/ICSI cycles with fresh single embryo transfer at the Department of Assisted Reproductive Medicine, Ghent University Hospital, Belgium, between July 2015 and August 2017 (n = 1053). A total of 118 endometriosis cases were matched 1:1 to 118 couples diagnosed with male subfertility and stratified by embryo quality (identical ALPHA grading categories), female age (±1 year) and parity (±1 delivery). Transvaginal ultrasound, magnetic resonance imaging or laparoscopy was used to diagnosed endometriosis, and the revised American Society for Reproductive Medicine score was used to classify the endometriosis into grade I/II versus grade III/IV. Male subfertility was defined in accordance with World Health Organization criteria (fifth edition).

Results

Compared with endometriosis cases, control couples with male subfertility had significantly higher rates of positive HCG test on day 16 (P = 0.047, OR 2.077, CI 1.009 to 4.276), ongoing implantation (defined as a positive fetal heart rate on transvaginal ultrasound at a gestational age of at least 6.5–7 weeks) (P = 0.038, OR 2.265, CI 1.048 to 4.893), ongoing pregnancy (defined by a vital pregnancy at 11 weeks) (P = 0.046, OR 2.292, CI 1.016 to 5.173) and live birth (P = 0.043, OR 2.502, CI 1.029 to 6.087).

Conclusions

After matching for embryo quality, woman's age and parity, rates of positive HCG tests, ongoing implantation, ongoing pregnancy and live birth were more than twice as high in the control group compared with the endometriosis group.

中文翻译：

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与同等质量胚胎移植后男性不育夫妇相比，子宫内膜异位症患者的着床受损：一项匹配队列研究

 研究问题

接受 IVF 和胞浆内单精子注射 (ICSI) 周期的子宫内膜异位症患者的着床是否受损？

 设计

2015 年 7 月至 2017 年 8 月期间，比利时根特大学医院辅助生殖医学科对采用新鲜单胚胎移植的 IVF/ICSI 周期进行了回顾性匹配队列研究（ n = 1053）。总共 118 例子宫内膜异位症病例以 1:1 的比例与 118 对诊断为男性生育力低下的夫妇进行匹配，并根据胚胎质量（相同的 ALPHA 分级类别）、女性年龄（±1 岁）和胎次（±1 次分娩）进行分层。采用经阴道超声、磁共振成像或腹腔镜检查诊断子宫内膜异位症，并使用修订后的美国生殖医学会评分将子宫内膜异位症分为I/II级与III/IV级。男性生育力低下的定义符合世界卫生组织标准（第五版）。

 结果

与子宫内膜异位症病例相比，男性不育症对照夫妇在第 16 天的 HCG 检测阳性率（ P = 0.047，OR 2.077，CI 1.009 至 4.276）、持续着床（定义为经阴道超声检查胎心率阳性）的比率显着较高。孕龄至少 6.5-7 周）（ P = 0.038，OR 2.265，CI 1.048 至 4.893），持续妊娠（定义为 11 周时有生命力的妊娠）（ P = 0.046，OR 2.292，CI 1.016 至 5.173）以及活产（ P = 0.043，OR 2.502，CI 1.029 至 6.087）。

 结论

在对胚胎质量、女性年龄和胎次进行匹配后，对照组的 HCG 检测阳性率、持续着床率、持续妊娠率和活产率是子宫内膜异位症组的两倍多。