Effect of Laparoscopic Surgery Combined with the Following Treatment of Gonadotropin-releasing Hormone Agonist on the Patients with Eendometriotic Infertility_West China Medical Journal

Authors：

 YANGLu ,  GAOJian-hong , WANGJing , LIUJin-fang , ZHANGYi , XIURui-jie

Department of Gynecology, Langfang People's Hospital, Langfang, Hebei 065000, P. R. China;

Corresponding author：

GAOJian-hong, Email: 1454658887@163.com

Keywords：

Endometriosis; Laparoscopy; Gonadotropin-releasing hormone agonist; Endometriosis fertility index; Infertility

DOI：

10.7507/1002-0179.20150359

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Objective To investigate the effect of laparoscopic surgery combined with the following treatment of gonadotropin-releasing hormone agonist (GnRH-a) on the patients with endometriotic infertility and the value of endometriosis fertility index (EFI) system on forecasting the pregnancy outcome. Methods From January 2005 to July 2011, the clinical data of 15 patients with endometriotic infertility patients were analyzed retrospectively. All the patients underwent laparoscopic surgery, and the effect was evaluated according to the endometriosis fertility index (EFI). Then all the patients were divided randomly into two groups on the basis of the different assisted treatment after the laparoscopic surgery:the control group (without any other therapy) and the GnRh-a group (combined with GnRH-a). Eventually, the pregnant rates were calculated respectively in the different groups or according to the different EFI. Results At last, 103 cases finished the follow-up. The pregnancy rate in the control group after 6 months, 1 year and 3 years therapy were 12.5%, 31.2%, and 41.7%, respectively; while in the GnRh-a group were 0%, 16.3%, and 40.0%, respectively. There were no difference between the two groups after the 1 year and 3 years therapy (P>0.05). Besides, all of the 55 cases in the GnRh-a group had side-effects, but no severe adverse effect was encountered. All the side-effects were disappeared after stopping the treatment. The pregnancy rate of the patients with the EFI score of 8-10 was respectively 31.3% 1 year and 62.5% 3 years after the treatment. However, the pregnancy rate of the patients with the EFI score of 5-7 was respectively 15.2% 1 year and 26.0% 3 years after the treatment. There were only 9 patients with the EFI score of 0-4, and all of them were not pregnant. The EFI score had positive correlation with the pregnancy rate 1 year and 3 years after the treatment (r_s=0.204, P=0.039; r_s=0.437, P<0.001). Conclusion The treatment of GnRh-a after the laparoscopic surgery can not only increase the rate of the pregnancy, but also delay the pregnancy occasion and increase the occurrence of the side-effects. The EFI may be valuable for forecasting the rate of pregnancy in patients with endometriotic infertility. The patients with EFI score higher than 8 may expect the pregnancy, while the ones with below 7 probably have much lower rate of natural pregnancy rate.

Citation： YANGLu, GAOJian-hong, WANGJing, LIUJin-fang, ZHANGYi, XIURui-jie. Effect of Laparoscopic Surgery Combined with the Following Treatment of Gonadotropin-releasing Hormone Agonist on the Patients with Eendometriotic Infertility. West China Medical Journal, 2015, 30(7): 1250-1254. doi: 10.7507/1002-0179.20150359 Copy

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5.	Alborzi S, Hamedi B, Omidvar A, et al. A comparison of the effect of short-term aromatase inhibitor (letrozole) and GnRH agonist (triptorelin) versus case control on pregnancy rate and symptom and sign recurrence after laparoscopic treatment of endometriosis[J]. Arch Gynecol Obstet, 2011, 284(1):105-110.
6.	Hughes E, Brown J, Collins JJ, et al. Ovulation suppression for endometriosis[J]. Cochrane Database Syst Rev, 2007, 18(3):CD000155.
7.	何茜冬, 张婷婷, 苏园园, 等. Ⅰ~Ⅱ期子宫内膜异位症不孕术后使用促性腺激素释放激素激动剂的随机对照研究[J]. 生殖医学杂志, 2014, 23(1):48-51.
8.	马晓玲, 秦天生, 张瑞, 等. 超长方案在子宫内膜异位症患者体外受精-胚胎移植中的价值探讨[J]. 生殖医学杂志, 2013, 22(7):536-539.
9.	Sallam HN, Garcia-Velasco JA, Dias S, et al. Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis[J]. Cochrane Database Syst Rev, 2006, 25(1):CD004635.
10.	De Ziegler D, Gayet V, Aubriot FX, et al. Use of oral contraceptives in women with endometriosis before assisted reproduction treatment improves outcomes[J]. Fertil Steril, 2010, 94(7):2796-2799.
11.	Society AF. Revised American fertility society classification of endometriosis:1985[J]. Fertil Steril, 1985, 43(3):351-352.
12.	Vercellini P, Fedele L, Aimi G, et al. Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis:the predictive value of the current classification system[J]. Hum Reprod, 2006, 21(10):2679-2685.
13.	Ma DO, Rock JA. Classification of endometriosis[J]. Semin Reprod Endocrinol, 1997, 15(3):235-244.
14.	魏代敏, 郁琦, 孙爱军, 等. 子宫内膜异位症生育指数与相关不孕患者腹腔镜术后妊娠的相关性[J]. 中华妇产科杂志, 2011, 46(11):806-808.

1. Missmer SA, Hankinson SE, Spiegelman D, et al. Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors[J]. Am J Epidemiol, 2004, 160(8):784-796.
2. Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility:a committee opinion[J]. Fertil Steril, 2012, 98(3):591-598.
3. Adamson GD, Pasta DJ. Endometriosis fertility index:the new, validated endometriosis staging system[J]. Fertil Steril, 2010, 94(5):1609-1615.
4. 冷金花, 史精华. 子宫内膜异位症及其相关手术对卵巢功能和生育的影响[J]. 实用妇产科杂志, 2012, 28(6):426-429.
5. Alborzi S, Hamedi B, Omidvar A, et al. A comparison of the effect of short-term aromatase inhibitor (letrozole) and GnRH agonist (triptorelin) versus case control on pregnancy rate and symptom and sign recurrence after laparoscopic treatment of endometriosis[J]. Arch Gynecol Obstet, 2011, 284(1):105-110.
6. Hughes E, Brown J, Collins JJ, et al. Ovulation suppression for endometriosis[J]. Cochrane Database Syst Rev, 2007, 18(3):CD000155.
7. 何茜冬, 张婷婷, 苏园园, 等. Ⅰ~Ⅱ期子宫内膜异位症不孕术后使用促性腺激素释放激素激动剂的随机对照研究[J]. 生殖医学杂志, 2014, 23(1):48-51.
8. 马晓玲, 秦天生, 张瑞, 等. 超长方案在子宫内膜异位症患者体外受精-胚胎移植中的价值探讨[J]. 生殖医学杂志, 2013, 22(7):536-539.
9. Sallam HN, Garcia-Velasco JA, Dias S, et al. Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis[J]. Cochrane Database Syst Rev, 2006, 25(1):CD004635.
10. De Ziegler D, Gayet V, Aubriot FX, et al. Use of oral contraceptives in women with endometriosis before assisted reproduction treatment improves outcomes[J]. Fertil Steril, 2010, 94(7):2796-2799.
11. Society AF. Revised American fertility society classification of endometriosis:1985[J]. Fertil Steril, 1985, 43(3):351-352.
12. Vercellini P, Fedele L, Aimi G, et al. Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis:the predictive value of the current classification system[J]. Hum Reprod, 2006, 21(10):2679-2685.
13. Ma DO, Rock JA. Classification of endometriosis[J]. Semin Reprod Endocrinol, 1997, 15(3):235-244.
14. 魏代敏, 郁琦, 孙爱军, 等. 子宫内膜异位症生育指数与相关不孕患者腹腔镜术后妊娠的相关性[J]. 中华妇产科杂志, 2011, 46(11):806-808.

West China Medical Journal

Effect of Laparoscopic Surgery Combined with the Following Treatment of Gonadotropin-releasing Hormone Agonist on the Patients with Eendometriotic Infertility

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