| Objective To analyze the fertility outcome after conservative surgery in ovarianendometriosis cyst. To evaluate the relationship between adjuvant therapyand the pregnant rate after surgery in ovarian endometriosis cyst.Methods A retrospective study was performed on81women with ovarianendometriosis cyst in the first hospital of Dalian medical university fromJanuary2009to December2012, who had been diagnosed by pathologyafter conservative surgery. They had been divided into three groups:38onlywith conservative surgery (Group A),35treated with gonadotropin-releasinghormone agonist (GnRH-a)(Group B),8treated with gestrinone (Group C).The pregnant outcomes were followed up by telephone and compared after amedian follow-up of36.6±15.6months (12~60months).Results1.In81patients after surgery,53of them got pregnancy, the total cumulativepregnancy rate was65.4%, and cumulative pregnant rates were68.4%(26/38),65.7%(23/35) and50%(4/8), respectively. There were nosignificantly differences in pregnant outcome among the three groups(p>0.05). Meanwhile each periods had significantly improved in pregnancyrate, and cumulative pregnancy rates were100%(5/5),61.4%(27/44),65.6%(21/32), There were no significantly differences in pregnant outcomeamong each periods (p>0.05).2. There were no significantly differences in median time of pregnancyamong the three groups (p>0.05); in each group, the pregnancy rate in first6months was significantly higher than other time periods (6months), and thehighest proportion of pregnancy rate were all within1years after operation,then gradually declined. 3. In group C, patients who had pregnancy were all less than35years old; Ingroup A and group B, less than35years of age pregnancy was significantlyhigher than that of other age groups, respectively80.8%and91.3%, patientsless than35years old who had pregnancy accounted for86.8%of allpregnancies, however, the pregnancy rate did not show a clear downwardtrend with the increase of age, there were no significantly differences inpregnant outcome among these age groups (p>0.05).4. Grouped according to the situation after pregnancy, found that pregnantand non-pregnant group the average age and age composition, CA125score,preoperative infertility, the side and the diameter of the mass, r-AFS scoreand Installment has nothing to do with the pregnancy outcomes; and surgerypath may be associated with pregnancy outcome.5. In53of pregnancy patients, the natural pregnancy rate was63%;37ofterm delivery, term delivery rate was45.7%, including17of group A,16ofgroup B (including2with IVF-EF),4of group C, and term delivery rateswere44.7%,45.7%,50%, respectively. There were no significantlydifferences in term delivery rates among the three groups (p>0.05);embryonic diapauses in3, embryonic diapauses rate was5.7%, including2in group A,1in group B, there were no significant difference (p>0.05);ectopic pregnancy, hydatidiform mole in1of group A, respectively.Conclusions1.Surgical treatment had done good to improve fertility, significantlyimproved pregnancy outcomes of ovarian endometriosis cysts patients. Withsurgery, ovarian endometriosis cysts patients can quickly restore fertility; thepregnancy rate in one year was the highest, with time, the advantagesgradually disappearance, the pregnancy rate declined, should strive for earlypregnancy.2. Surgical treatment can improve pregnancy rates of each peace the ovarianendometriosis cyst patients, fertility of III, IV periods improve better than ofI-II periods, intraoperative and postoperative phases r-AFS pregnancy is not relevant, that is, intraoperative and postoperative phases of fertility nopredictive value.3.35-year-old is not the Standard for ovarian endometriosis cysts onpregnancy outcome.4. Adjuvant therapy had not beneficial on improving pregnancy outcomes,was not recommended in patients with urgent fertility requests.5. The fertility rate of assisted reproductive technology was significantlyhigher than that of natural conception, postoperative pregnancy test fail forpregnant in2years, the natural pregnancy probability is low, suggested theassisted reproductive technology to improve the pregnancy rate.6. Not yet confirmed pregnancy outcomes associated with surgical path,needs to be confirmed by RCT. |
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