| Objective: To evaluate the effect of GnRHA(Gonadotropin releasinghormone agonist)on postoperative clinical pregnancy and related factors of endometriosis combined with infertility after laparoscopy.Methods: A total of 113 patients with ectopic infertility during stage III-IV laparoscopic surgery in our hospital from 2010 to 2020 were collected,including 7patients who received assisted reproductive technology after surgery,and 106 patients who were pregnant during natural cycle after surgery.According to the postoperative use of GnRHA,106 patients in the self-phase period were included in the group,and 3patients who received GnRHA greater than 3 injections were excluded..The 103 patients who received GnRHA 0-3 injection were divided into three groups: 36 patients in the simple laparoscopic surgery group(Group A),26 patients in the group that received 1-2injections of GnRHA after surgery(Group B),and 41 patients in the group that received3 injections of GnRHA(Group C)after surgery.The cumulative pregnancy rate within 2years after operation was compared between different groups.According to postoperative pregnancy of group A and group C,the two groups were respectively divided into pregnant group(group a)and non-pregnant group(group b).Comparison was made between group a and group b for single factor differences,including overall EFI(endometriosis fertility index)and LF(least function),average AFS score and primary infertility rate(%)between groups.In 103 patients with natural expectant pregnancy after stage III-IV surgery,the influence of various factors on natural pregnancy was analyzed by Logistic multivariate linear regression,and independent risk(or protective)factors were found.Kaplan-Meier survival analysis curve was used to compare postoperative non-gestational time between groups,so as to further screen and verify different pregnancy-related factors.According to the results of the comprehensive analysis and evaluation of postoperative natural pregnancy and related factors,to provide the basis for the clinical development of the correct pregnancy strategy.(All LF scores mentioned in this paper refer to partial EFI scores corresponding to the lowest fallopian tube function in the overall EFI scoring system,ranging from 0 to 3 points)Results: 1.The cumulative pregnancy rate was 41.7%,46.2% and 73.2% in group A,B and C,respectively,and the difference was statistically significant(P<0.05).Further pairwise comparison between groups showed that group C was significantly higher than group A and group B(P<0.05);There was no difference between group A and group B(P>0.05).2.The cumulative pregnancy rate of group A reached 30.6% at 6 months and 41.9% at 1 year,while the cumulative pregnancy rate of group B and C reached 26.9% and 19.5% respectively.The pregnancy rate of group C increased from 7 to 12 months after surgery,and reached the peak(73.2%)one and a half years later.The cumulative pregnancy rate in group C was 61.0% at 1 year after operation,which was significantly higher than that in group C(31.3% at 13-18months).The pregnancy rate of 6-12 months postoperatively in group C(51.5%)was significantly higher than that in group A(P<0.05);After 0-6 months,it was lower than group A,but there was no statistical significance(P=0.262).3.In the simple endoscopic surgery group,the mean value of EFI and LF in group a were both higher than that in group b,and the proportion of primary infertility in group a was significantly lower than that in group b,the differences were significant(P<0.05).However,in the postoperative+3 GnRHA group,there was no significant difference in average EFI between group a and group b(P>0.05).4.Binary logistic regression analysis showed that: LF ≦ 2 and LF>2 分;There was significant difference between 2 groups(P=0.000,OR=0.063<1);The effect of primary infertility on pregnancy was different from that of secondary infertility(P=0.002,OR=0.158<1);Different EFI grades(5-7 points VS 8-10points),AFS stages(stage III VS stage IV)and other factors had no independent effect on pregnancy(P>0.05).Conclusion: 1.The natural cycle pregnancy rate of patients with moderate and severe endometriosis after laparoscopy was 41.7%.It is suggested that laparoscopic surgery can improve the pregnancy rate of patients with endometriosis.2.In patients with moderate and severe endometriosis,endoscopic surgery combined with 3 cycles of GnRHA could prolong the optimal time of pregnancy and increase the postoperative pregnancy rate(73.2% VS 41.7%).3.EFI,LF and primary infertility are related to postoperative natural pregnancy.For primary endometriosis infertility patients with EFI≦7 and LF≦2,assisted reproductive technology should be actively recommended;And EFI>7 points,LF> 2 points Patients with of endometriosis can apply GnRHA for natural cycle assisted pregnancy after surgery,and those who still fail to become pregnant one year after surgery need to be re-evaluated.The age<30 years old infertile patients with good ovarian reserve,no primary infertility,and no recurrence of endometriosis can appropriately extend the natural cycle assisted pregnancy time to one and a half years after the operation. |
PDF Full Text Request