| Objective:To investigate factors affecting pregnancy after operation in Ovarian endometriosis(OEM)patients in childbearing age,and to explore the predictive value of anti-Müllerian hormone(AMH),Neutrophil/lymphocyte ratio(NLR)level and least function score(LF score)for pregnancy after OEM surgery,in order to make up for the deficiency of the fertility index(EFI)and provide fertility guidance for OEM women with fertility needs.Methods:A total of 896 patients undergoing EMS operation from the First Hospital of Shanxi Medical University and the Ninth Clinical Medical College of Shanxi Medical University from January 2019 to January 2021 were retrospectively collected,778 patients with intraoperative resection of accessories,other types of EMS and no pregnancy need after surgery were excluded,and 118 OEM patients with fertility need were included in the study.General clinical data,ectopic lesion characteristics,intraoperative fallopian tube lesions,preoperative Carbohydrate antigen 125(CA125),preoperative serum NLR,preoperative serum AMH level,preoperative sex hormone 6 items and postoperative drug use were collected.For one year,The patients were divided into pregnant group and non-pregnant group according to their pregnancy condition.By analyzing the clinical characteristics of the two groups of OEM patients,univariate analysis and multivariate Logistic regression analysis were used to discusse the factors affecting the postoperative pregnancy,ROC curve were drawed and explore the predictive value of serum NLR,AMH level and LF score for postoperative pregnancy.Results:1、There were 118 OEM patients with reproductive needs,and they were followed up for one year after operation.Among them,79 cases(66.95%)were successful in natural pregnancy,and 39 cases(33.05%)were unsuccessful in pregnancy.Among them,55 cases were successful in direct pregnancy test,29 cases were successful in pregnancy test after half a year’s failure,and 24 cases were successful in pregnancy test,and 34 cases insisted on natural pregnancy test.2、Univariate analysis showed that the duration of the disease,the number of abortions,the previous history of ovarian surgery,adenomyosis,NLR,AMH,lateral cyst,pathological type of cyst,ASRM stage,LF score,the number and duration of bipolar electrocoagulation during operation and the use of ovulation induction drugs after operation were the main factors affecting the pregnancy after OEM(P<0.05).3、The changes of serum AMH in OEM patients showed that the levels of serum AMH in patients with unilateral ovarian cyst and pregnant group were higher than those in patients with bilateral ovarian cyst and non-pregnant group before and after operation,with a statistically significant difference(P < 0.05).Three months post-operation,the serum AMH level in each group was significantly lower than that before operation(P < 0.05).However,the serum AMH level in each group was still lower than that before operation 6months after operation,but it was statistically significant only in the group with bilateral ovarian cysts(P < 0.05).4、An independent factor influencing pregnancy in OEM patients was revealed by multivariate Logistic regression analysis to be Uterine adenomyosis(OR=0.615,P=0.006),bilateral cyst(OR=0.727,P=0.087),NLR(OR=4.437,P=0.008),AMH(OR=2.011,P=0.019),and LF score(OR=2.311,P=0.000).5、ROC curve shows: The sensitivity of preoperative NLR,AMH,LF score,NLR combined with AMH,NLR combined with LF score,AMH combined with LF score,and NLR,AMF and LF score combined with NLR,AMF and LF score to predict pregnancy after laparoscopic surgery in OEM patients was 71.8%,76.9%,51.3%,74.4%,67.9%,60.3%,respectively.The specificity was 66.7%,61.5%,100%,74.4%,62.8%,60.3%,and the AUC was 0.711,0.728,0.791,0.776,0.861,0.857,0.899,respectively.The combined prediction value of the three was higher,and the cut-off value was 0.714.Conclusion:1.The duration of the disease,the number of abortions,the previous history of ovarian surgery,adenomyosis,NLR,AMH,lateral cysts,pathological types of cysts,ASRM staging,LF score,the number and duration of bipolar electrocoagulation during operation and the use of ovulation induction drugs after operation are the main factors that affect the pregnancy after OEM,among which adenomyosis,bilateral cysts,NLR,AMH and LF scores are the independent factors that affect the pregnancy.2.OEM disease itself and surgical treatment will affect the fertility of patients,especially in patients with bilateral ovarian cysts.After operation,AMH is obviously reduced and it is not easy to return to the preoperative level,so Protection of ovarian function of OEM patients should be paid attention to.3.The combination of preoperative NLR,AMH and LF scores has a good predictive value for the pregnancy of OEM patients after operation.Women with a combined value of above 0.714 can try to conceive naturally after operation,otherwise it is suggested to choose appropriate assisted reproductive technology. |
