不同病变类型子宫内膜异位症对卵巢储备功能及辅助生殖技术结果的影响

摘要 目的：探究不同病变类型子宫内膜异位症（Endometriosis，EMs）对卵巢储备功能及辅助生殖技术结果的影响。方法：选择2018年1月-2021年1月于承德医学院附属医院妇产科就诊的EMs合并不孕症患者188例作为研究对象，纳入实验组，另随机选择同期单纯男性因素不孕妇女160例作为对照。对符合临床标准的患者行IVF-ET治疗，计算其胚胎种植率、临床妊娠率、活产率，对患者血清抗苗勒氏管激素（AWH）、卵泡刺激素（FSH）、黄体生成素（LH）、窦卵泡素（AFC）水平进行检测。结果：r-AFS III期、IV期AWH水平显著低于对照组，差异具有统计学意义（t=7.00、11.86，P均<0.05）；II期、III期、IV期AFC计数显著低于对照组，差异具有统计学意义（t=4.50、8.49、9.06，P均<0.05）。r-AFS分期III期、IV期患者种植率、临床妊娠率、活产率显著低于对照组（x²=4.04、4.72、10.46、8.80、11.32、12.21，P均<0.05）。多因素logistic回归分析结果表明，r-AFS分期III期、IV期是IVF-ET不良结局的主要危险因素，具有统计学意义（P<0.05）。结论：III/IV期EMs可在一定程度上降低妇女的卵巢储备功能，同时降低了IVF-ET过程中的种植率及临床妊娠率，从而对其妊娠结局产生不良的影响。

Effects of Different Lesion Types of Endometriosis on Ovarian Reserve Function and Assisted Reproductive Technology

ABSTRACT Objective: To investigate the effects of different types of endometriosis (EMs) on ovarian reserve function and assisted reproductive technology. Methods: 188 patients with EMS complicated with infertility treated in the Department of gynecology and obstetrics of the Affiliated Hospital of Chengde Medical College from January 2018 to January 2021 were selected as the research objects and included in the experimental group. In addition, 160 infertile women with simple male factors in the same period were randomly selected as the control. IVF-ET treatment was performed on patients who met the clinical criteria, and the embryo implantation rate, clinical pregnancy rate, and live birth rate were calculated. The patient''s serum anti-Mullerian hormone (AWH), follicle stimulating hormone (FSH), and luteinizing hormone (LH), antral follicle stimulating hormone (AFC) levels were tested. Results: The levels of AWH in stage III and stage IV of r-AFS were significantly lower than those in the control group (t=7.00, 11.86, P<0.05). The AFC counts in stage II, III and IV were significantly lower than those in the control group. The difference was statistically significant (t=4.50, 8.49, 9.06, P<0.05). The implantation rate, clinical pregnancy rate and live birth rate of patients with stage III and stage IV of r-AFS were significantly lower than those of the control group (x²=4.04, 4.72, 10.46, 8.80, 11.32, 12.21, P<0.05). Multivariate logistic regression analysis showed that stage III and IV of r-AFS stage were the main risk factors for IVF-ET adverse outcome, which was statistically significant (P<0.05). Conclusion: Stage III/IV EMs can reduce women''s ovarian reserve function to a certain extent, and reduce the implantation rate and clinical pregnancy rate during IVF-ET, which may have adverse effects on pregnancy outcome.