| Objective: To investigate whether there is a difference in pregnancy rate between laparoscopic conservative operation and postoperative combined Gn RH-a treatment for moderate and severe endometriosis.Individualized treatment of patients with different stages according to the endometriosis fertility index score(EFI).Methods: A retrospective analysis was performed on 406 patients with moderate to severe endometriosis treated with laparoscopic conservative surgery in the obstetrics and gynecology hospital of Dalian from January 1,2013-January 1,2016.According to whether combined with Gn RH-a treatment after surgery,the study group and the control group were divided.The study group started active pregnancy test after 3-6months of laparoscopic conservative surgery combined with Gn RH-a treatment.The control group was treated with conservative laparoscopic surgery,and after 1 month,the test was resumed and the active pregnancy was started.Serum human chorionic gonadotropin positive(Serum human chorionic gonadotropin > 5 m IU/ L)is the standard for determining pregnancy.Without further discussion of the pregnancy outcome,even if spontaneous abortion,embryonic death,etc.occur during pregnancy,it is planned to be a category of pregnancy.Followed up for 3 years by telephone.The follow-up included whether there was a fertility requirement after surgery,whether it was combined with Gn RH-a treatment,pregnancy,pregnancy time,and pregnancy.The age,previous pregnancy,infertility time,r-AFS score,EFI score,pregnancy time and pregnancy of the two groups were recorded.Result:The cumulative pregnancy rate of the study group was 48.90%(133/272)one year after treatment was higher than the cumulative pregnancy rate was 36.57%(49/134)after one year of treatment.The difference was statistically significant(?~2=5.518,P=0.019).The cumulative pregnancy rate of the study group was 61.76%(168/272)2years after treatment was higher than the cumulative pregnancy rate of the control group was 49.25%(66/134).The difference was statistically significant(?~2=5.755,P=0.016).The cumulative pregnancy rate of the study group was 65.07%(177/272)after treatment for 3 years was higher than the cumulative pregnancy rate was 51.49%(69/134)after treatment for 3 years.The difference was statistically significant(?~2=6.934,P=0.008).The pregnancy rate of the study group at 12 months after treatment was 48.90%(133/272),which was higher than the 12-24 month pregnancy rate of 12.87%(35/272),which was higher than the 24-36 month pregnancy rate of 3.31%(9/272).The pregnancy rate of the control group at 12 months after treatment was 36.57%(49/134),which was higher than the 12-24 month pregnancy rate of 12.67%(17/134),which was higher than the 24-36 month pregnancy rate of 2.24%(3/134).The study group EFI score 8-10 points cumulative pregnancy rate 79.41%(108/136)higher than the control group EFI score 8-10 points cumulative pregnancy rate 71.43%(45/63),the difference was not statistically significant(?~2=1.506,P=0.220).The study group EFI score 5-7points cumulative pregnancy rate 53.17%(67/126)higher than the control group EFI score 5-7 points cumulative pregnancy rate 35.82%(24/67),The difference was statistically significant(?~2=5.344,P=0.021).The study group EFI score 0-4 points cumulative pregnancy rate 20%(2/10)higher than the control group EFI score 0-4points cumulative pregnancy rate 0(0/4),the difference was not statistically significant(?~2=1.147,P= 0.225).Conclusion: The use of Gn RH-a after laparoscopic conservative surgery in patients with moderate or severe endometriosis can improve the postoperative pregnancy rate compared with laparoscopic surgery alone.Regardless of whether or not Gn RH-a is combined with surgery,the first year after treatment is the period with the highest pregnancy rate.For patients with EFI score of 8-10,an active pregnancy test can be started after surgery.For example,if the pregnancy is not cured for 1 year,it is recommended that the gynaecological clinic or reproductive clinic should be re-evaluated by an experienced physician to see if there are other causes of infertility.For patients with EFI score of 5-7,it is recommended to use Gn RH-a after surgery.After the treatment,you can start active pregnancy test.If you 1 year without pregnancy,It can assist pregnancy by monitoring ovulation to guide the sexual intercourse,controlled over-speed ovulation,intrauterine insemination and in vitro fertilization-embryo transfer.For patients with EFI score of 0-4,it is recommended to use Gn RH-a after surgery.Immediately after treatment,the patient will be seen in the reproductive clinic.Human intervention should be performed as soon as possible.IVF-ET is recommended to avoid the best time to miss the pregnancy. |
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