Analysis Of Related Factors Of Non-ART Pregnancy After Laparoscopic Conservative Surgery In Women With Endometriosis Associated With Infertility And Evaluation Of Endometriosis Fertility Index

ObjectiveTo investigate the influencing factors of non-ART pregnancy after laparoscopic conservative surgery and determine the predictive value of the Endometriosis Fertility Index for the outcome of cumulative pregnancy in non-ART pregnancy.MethodsFrom June 2015 to June 2017 in Henan University People’s Hospital laparoscopic conservative surgery and follow-up data of 420 patients with endometriosis and infertility in patients with clinical data,The data were analyzed by IBM SPSS 25.0.Results1.This study showed that in patients with endometriosis associated with infertility,190 patients with non-ART pregnancy within 2 years after laparoscopic conservative surgery,the non-ART pregnancy rate was 45.24%（190/420）,Postoperative 101 cases of non-ART pregnancy within 6 months,53 cases of non-ART pregnancy within 7 to 12 months,23 cases of non-ART pregnancy from 13 to 18 months,13cases of non-ART pregnancy from 19 to 24 months and non-ART pregnancy rate respectively was24.05%（101/420）,12.62%（53/420）,5.48%（23/420）,3.10%（13/420）.2.Compared with the 7 days before surgery,the serum FSH levels in 3 months and 6 months after surgery were significantly increased（P<0.05）;compared with the 7 days before surgery,the serum AMH and combined AFC in 3 months after surgery were both significantly decreased（P<0.05）;compared with the 7 days before surgery,serum E₂,AMH and AFC combined with clever cysts decreased at 6 months after surgery,but there was no statistical significance（P>0.05）.3.The univariate analysis indicated that significant identify factors of non-ART pregnancy outcome were patient age（P=0.000）,infertility years（P=0.001）,adenomyosis（P=0.000）,previous history of gynecological inflammation（P=0.039）,previous history of surgery（P=0.000）,EFI score（P=0.000）,the postoperative Gn RH-αdrug（P=0.044）,assisted conception（P=0.044）.4.The multivariate analysis showed that higher age（OR=1.621,P=0.014）,prolonged infertility（OR=2.289,P=0.016）,combined adenomyosis（OR=1.920,P=0.004）and previous history of surgery（OR=1.965,P=0.009）were the independent risk factors for postoperative non-ART pregnancy and the higher EFI score（OR=0.846,P=0.010）,assisted conception（OR=0.863,P=0.032）were were independent protective factors for postoperative non-ART pregnancy.5.The non-ART cumulative pregnancy rate of women with fertility index of 0～4,5～7 and 8～10 after laparoscopic conservative surgery respectively were13.48%（12/89）,42.75%（59/138）,61.66%（119/193）.6.The non-ART pregnancy rate of women who took ovulation-promoting sexual intercourse and intrauterine artificial insemination（IUI）was significantly higher than that of naturally pregnant women in EFI 0～4 and 5～7（P<0.0167）.7.The non-ART pregnancy rate of women with ovulatory cycle in IUI was significantly higher than that of women with natural cycle in EFI 0～4 and 5～7（P<0.05）.Conclusions1.The laparoscopic conservative surgery can improve non-ART pregnancy rate.2.Patient age,infertility years,adenomyosis,and previous history of surgery could increase the risk of infertility after laparoscopic conservative surgery,so fertility guidance should be actively provided for these patients.3.The EFI scores can accurately assess the non-ART pregnancy outcome of women who take non-ART methods after laparoscopic conservative surgery,which helps clinicians to personally guide patients to fertility:（1）Patients with low score（EFI≤4）,in order to save the time of conception and improve the chances of conception,it is recommended to try 1 to 3 cycles of IUI to assist pregnancy.If it fails,then directly perform in vitro fertilization（IVF）.（2）Patients with medium score（EFI 5～7）can take regular ovulation or IUI to assist pregnancy according to the actual clinical situation and the wishes of patients.（3）Patients with high score（EFI 8～10）can expect natural conception after laparoscopic conservative surgery.