Effects Of Postoperative GnRH-a Therapy After Laparoscopic Ovarian Endometriosis Cystectomy On Pregnancy Outcomes: A Meta-analysis

Background: The incidence of infertility in patients with endometriosis was as high as 50% in recent years,while the incidence of infertility in women with endometriosis was 20%-50%,which was 6-8 times of the fertility women.Therefore the occurrence of infertility is closely related to endometriosis.Now the laparoscopic surgery,surgery and drug treatment is considered as the gold standard treatment of endometriosis,and laparoscopic ovarian ectopic cystectomy is the first choice for endometriosis treatment.Because endometriosis is a hormone-dependent disease,the postoperative recurrence rate、residual lesions and other issues are particularly high.Therefore the application of postoperative drug therapy was more and more widely used that GnRH-adrugs are the most widely used.The efficacy on recurrence of endometriosis and the control of clinical symptoms is obvious,but for patients with postoperative pregnancy rate,the impact of pregnancy outcome is not clear.The mechanism of postoperative GnRH-a treatment is inhibiting the secretion of pituitary gonadotropin,leading to ovarian secretion of sex hormones and reduce residual ectopic endometrial atrophy,degradation,necrosis,and improve the pelvic microenvironment to reduce peritoneal fluid production,improve endometrial tolerance,improve the compliance of the fallopian tube,thereby improve the pregnancy outcomes.The aim of the study is to evaluate the pregnancy rate and spontaneous abortion,ectopic pregnancy,and term live birth in order to provide evidence-based medical evidence forclinical treatment.Objects: To evaluate the effects of postoperative GnRH-a therapy after laparoscopic ovarian endometriosis cystectomy on pregnancy.Methods: Cochrane system was used to evaluate the effects of postoperative GnRH-a therapy after laparoscopic ovarian endometriosis cystectomy on pregnancy according to the principle of forensic medicine.We searched the following databases:PUBMED,MEDLINE,EMBASE,CNKI,Wanfang,Weipu.Screening of the literature,and then extract the relevant data from the included literatures during the 2006-2016 period.Review manager 5.3 was used to ananlyse the data we extracted.The cases were divided into two groups: good-pregnancy-outcomes-groups inclued pregnancy rate and full-term-birth-rate,adverse-pregnancy-outcomes-groups inclued spontaneous abortion rate and ectopic pregnancy rate.Results: 1.There are 8 articles in accordance with the requirements of the literatures.A total of 997 cases of patients were included in the study.The experimental group have 636 cases of postoperative GnRH-a therapy.The control grouphave 361 patients.2.The meta-analysis results: Compared with the pure laparoscopic surgery group,the postoperative GnRH-a therapy group have higher pregnancy rate,higher full-term-birth-rate,and the difference was statistically significant;but there were no statistical significant differences between spontaneous abortion rate,ectopic pregnancy rate and the adverse pregnancy outcomes rate.Conclusion: The postoperative GnRH-a therapy after laparoscopic ovarian endometriosiscystectomy can improve the pregnancy rate,live births rate.And there was no statistically significant difference in improving the adverse pregnancy outcomes,which may be associated with less sample size.