Should patients undergo endometrioma surgery before IVF/ICSI? a retrospective study with propensity score matching.

IF 3.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Reproductive Health Pub Date : 2025-09-30 DOI:10.1186/s12978-025-02141-8

Wumin Jin, Xia Chen, Xiaojing Lin, Zixuan Zheng, Qiuzi Shi, Linchai Zeng, Chang Liu, Xuefeng Huang, Yili Teng, Peipei Pan

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引用次数: 0

Abstract

Research question: Does surgical management of ovarian endometriomas improve in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)?

Design: This retrospective study analyzed 1,456 IVF/ICSI cycles from June 2017 to September 2022, comparing 530 control cycles with 926 endometriosis (EMS) cycles. The EMS group comprised pre-EMS (non-operated endometriomas, N = 272) and post-EMS (operated endometriomas, N = 654) subgroups. Propensity score matching (PSM) balanced female age, antral follicle count (AFC), body mass index (BMI), anti-Müllerian hormone (AMH), follicle stimulating hormone (FSH), and estradiol levels. Receiver operating characteristic (ROC) analyses identified potential predictors of high-quality D3 embryos and live birth.

Results: After PSM, the EMS group showed significantly lower normal fertilization rates, D3 embryo rates, and ovarian sensitivity index (OSI) compared to the control group (P < 0.05), but comparable oocyte yield, fertilization outcomes, and embryo parameters. Subgroup analysis showed that advanced-stage post-EMS cases had fewer retrieved oocytes and embryos, along with lower OSI, than the pre-EMS group after PSM. LBRs were similar between the EMS and control groups, irrespective of prior endometrioma surgery. ROC analysis identified AMH (cutoff 1.17 ng/mL; AUC 0.703, 95% CI 0.654-0.752) and AFC (cutoff 7.5; AUC 0.670, 95% CI 0.621-0.720) as predictors of high-quality day-3 embryos in EMS patients. In post-EMS patients, AMH (cutoff value 1.175; AUC 0.703, 95% CI 0.647-0.759) and AFC (cutoff 6.5; AUC 0.667, 95% CI 0.608-0.725) were predictive. AMH, AFC, age, and endometrioma size did not predict live birth.

Conclusion: Advanced-stage Endometriosis negatively impacts oocyte quantity and ovarian response, but endometrioma surgery may not improve these outcomes or LBRs. Following exclusion of malignancy, asymptomatic endometriosis patients with AMH ≤ 1.17 ng/mL or AFC ≤ 7 should not routinely undergo cystectomy.

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患者在体外受精/ICSI前是否应该接受子宫内膜瘤手术？倾向评分匹配的回顾性研究。

研究问题：卵巢子宫内膜瘤的手术治疗是否能改善体外受精(IVF)/胞浆内单精子注射（ICSI）？设计：本回顾性研究分析了2017年6月至2022年9月期间的1456个IVF/ICSI周期，比较了530个对照周期和926个子宫内膜异位症（EMS）周期。EMS组包括EMS前（未手术子宫内膜瘤，N = 272）和EMS后（手术子宫内膜瘤，N = 654）亚组。倾向评分匹配（PSM）平衡了女性年龄、窦卵泡计数（AFC）、体重指数（BMI）、抗勒氏杆菌激素（AMH）、促卵泡激素（FSH）和雌二醇水平。受试者工作特征（ROC）分析确定了高质量D3胚胎和活产的潜在预测因素。结果：经PSM后，EMS组正常受精率、D3胚胎率和卵巢敏感性指数（OSI）均显著低于对照组（P < 0.05），但卵母细胞产量、受精结果和胚胎参数与对照组相当。亚组分析显示，晚期ems后患者在PSM后获得的卵母细胞和胚胎较少，OSI也较低。无论是否有子宫内膜异位瘤手术，EMS组和对照组的lbr相似。ROC分析确定AMH（截断值1.17 ng/mL； AUC为0.703,95% CI为0.654-0.752）和AFC（截断值为7.5；AUC为0.670,95% CI为0.621-0.720）是EMS患者高质量第3天胚胎的预测因子。在ems后患者中，AMH（截止值1.175;AUC 0.703, 95% CI 0.647-0.759）和AFC（截止值6.5;AUC 0.667, 95% CI 0.608-0.725）具有预测作用。AMH、AFC、年龄和子宫内膜瘤大小不能预测活产。结论：晚期子宫内膜异位症对卵母细胞数量和卵巢反应有负面影响，但子宫内膜异位症手术可能不会改善这些结果或lbr。排除恶性肿瘤后，AMH≤1.17 ng/mL或AFC≤7的无症状子宫内膜异位症患者不应常规行膀胱切除术。

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

Reproductive Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

6.00

自引率

5.90%

发文量

220

审稿时长

>12 weeks

期刊介绍： Reproductive Health focuses on all aspects of human reproduction. The journal includes sections dedicated to adolescent health, female fertility and midwifery and all content is open access. Reproductive health is defined as a state of physical, mental, and social well-being in all matters relating to the reproductive system, at all stages of life. Good reproductive health implies that people are able to have a satisfying and safe sex life, the capability to reproduce and the freedom to decide if, when, and how often to do so. Men and women should be informed about and have access to safe, effective, affordable, and acceptable methods of family planning of their choice, and the right to appropriate health-care services that enable women to safely go through pregnancy and childbirth.