Impact of surgery on reproductive outcomes in women with deep endometriosis and proven presurgical infertility: Facts and controversies

IF 3.9 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
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引用次数: 0

Abstract

In women with proven infertility and deep endometriosis (DE), optimal management is controversial. To date, there is no clear evidence on the association between infertility and different stages of rASRM, nor is there clear guidance from leading scientific societies for surgical treatment of DE patients. A comprehensive literature search was conducted on the main databases for English-language trials describing the effectiveness of surgery for DE in patients with proven infertility; 16 studies were deemed eligible for inclusion in this systematic review (CRD42024498888). Quantitative analysis was not possible because of the heterogeneity of the data. A descriptive summary of the results according to location of pathology, surgical technique used, and whether assisted reproductive technology (ART) was needed or not was provided.

A total of 947 infertile women were identified, 486 of whom became pregnant, with an average pregnancy rate of 51.3%. Our review suggests that surgery can be of valuable help in improving reproductive outcomes by improving the results of ART. It has not been possible to reach robust conclusions on the outcomes of surgery based on the location of DE because of the heterogeneity of evidence available to date.

Overall, although some data encourage first-line surgical management, further investigation is needed to determine its effective application before or after ART failure.

手术对患有深部子宫内膜异位症并经证实在手术前不孕的妇女生育结果的影响:事实与争议。
对于已证实患有不孕症和深部子宫内膜异位症(DE)的妇女,最佳治疗方法还存在争议。迄今为止,尚无明确证据表明不孕症与不同阶段的 rASRM 之间存在关联,主要科学协会也未就 DE 患者的手术治疗提供明确指导。我们在主要数据库中进行了一次全面的文献检索,以了解对已证实不孕的 DE 患者进行手术治疗的有效性;有 16 项研究被认为符合纳入本系统性综述的条件(CRD42024498888)。由于数据的异质性,无法进行定量分析。根据病理位置、使用的手术技术以及是否需要辅助生殖技术(ART)对结果进行了描述性总结。共发现了 947 名不孕妇女,其中 486 人怀孕,平均怀孕率为 51.3%。我们的研究结果表明,手术可以通过改善抗逆转录病毒疗法的效果,在改善生殖结果方面提供宝贵的帮助。由于迄今为止获得的证据不尽相同,因此无法根据DE的位置对手术效果得出可靠的结论。总体而言,尽管一些数据鼓励一线手术治疗,但仍需进一步研究,以确定在抗逆转录病毒疗法失败之前或之后有效应用手术治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
9.40
自引率
1.80%
发文量
113
审稿时长
54 days
期刊介绍: In practical paperback format, each 200 page topic-based issue of Best Practice & Research Clinical Obstetrics & Gynaecology will provide a comprehensive review of current clinical practice and thinking within the specialties of obstetrics and gynaecology. All chapters take the form of practical, evidence-based reviews that seek to address key clinical issues of diagnosis, treatment and patient management. Each issue follows a problem-orientated approach that focuses on the key questions to be addressed, clearly defining what is known and not known. Management will be described in practical terms so that it can be applied to the individual patient.
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