Factors Associated With Spontaneous Conception Leading to Live Birth in Infertility Patients After Endometriosis Surgery

IF 3.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology Pub Date : 2025-03-22 DOI:10.1016/j.jmig.2025.03.010

Anthony D. Nguyen MD , Hannah L. Marshall MD , Meg W. Sidle PhD , Veronica D. Galaviz MD , Peter L. Sticco MD , Keith T. Downing MD

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引用次数: 0

Abstract

Study Objective

To determine factors associated with spontaneous conception leading to live birth in infertility patients after endometriosis surgery.

Design

Retrospective cohort study.

Setting

Multi-hospital health system of Catholic Health in Long Island, NY.

Participants

Infertility patients, between ages 18 and 45, who underwent endometriosis surgery with complete excision or ablation with or without excision and continued follow-up care for at least 1 year between January 1^st, 2016 and March 31^st 2022.

Main results

Of the 100 patients, 50 achieved spontaneous conception and 40 achieved live birth within 1 year of surgery. Age less than 35 at the time of surgery was found to have an increased likelihood of live birth (RR 3.1, 95% CI 1.3–7.2). Being overweight (RR 1.0, 95% CI 0.4–2.2) or obese (RR 1.2, 95% CI 0.4–3.1) did not affect the likelihood of live birth. Surgery within 24 months of infertility diagnosis did not increase the likelihood of a successful delivery (RR 2.0, 95% CI 0.9–4.5). The pregnancy rate for AAGL Stage I, II, III, IV endometriosis were 42% (18/32), 32% (8/25), 46% (6/13), 42% (8/19) respectively. The logistic regression model indicated that live birth after spontaneous conception was significantly associated with younger age at the time of surgery and complete excision of endometriosis. Patients were 3.2 times (95% CI 1.3-7.8) more likely of having a live birth if they were less than 35 years old at the time of surgery. Complete excision of endometriosis conferred a 4.1-fold (95% CI 1.1–14.9) increased likelihood of a live birth.

Conclusion

Two factors increased the likelihood of live birth after endometriosis surgery: age at the time of surgery and complete excision of endometriosis. We cautiously recommend patients attempting spontaneous conception find an endometriosis surgeon proficient in excisional techniques. If they are under 35, there may be additional benefit from surgery.

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子宫内膜异位症术后不孕患者自然受孕导致活产的相关因素。

研究目的：探讨子宫内膜异位症术后不孕患者自然受孕导致活产的相关因素。设计：回顾性队列研究。环境：纽约长岛天主教健康的多医院卫生系统。参与者：年龄在18至45岁之间的不孕症患者，在2016年1月1日至2022年3月31日期间接受了子宫内膜异位症手术，并进行了完全切除或消融（有或没有切除），并继续随访治疗至少一年。主要结果：100例患者手术1年内自然受孕50例，活产40例。手术时年龄小于35岁的患者活产的可能性增加（RR 3.1, 95% CI 1.3-7.2）。超重（RR 1.0, 95% CI 0.4-2.2）或肥胖（RR 1.2, 95% CI 0.4-3.1）不影响活产的可能性。诊断不孕症后24个月内进行手术并没有增加成功分娩的可能性（RR 2.0, 95% CI 0.9-4.5）。AAGLⅰ、ⅱ、ⅲ、ⅳ期子宫内膜异位症的妊娠率分别为42%（18/32）、32%（8/25）、46%（6/13）、42%（8/19）。logistic回归模型显示，自然受孕后的活产与手术时年龄较小和子宫内膜异位症完全切除有显著相关性。手术时年龄小于35岁的患者活产的可能性高出3.2倍（95% CI 1.3-7.8）。完全切除子宫内膜异位症使活产的可能性增加4.1倍（95% CI 1.1-14.9）。结论：子宫内膜异位症手术后活产的可能性增加两个因素：手术时的年龄和子宫内膜异位症的完全切除。我们谨慎地建议尝试自然受孕的患者找一位精通切除技术的子宫内膜异位症外科医生。如果他们在35岁以下，手术可能会有额外的好处。

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

Journal of minimally invasive gynecology 医学-妇产科学

CiteScore

5.00

自引率

7.30%

发文量

272

审稿时长

37 days

期刊介绍： The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.