内异症的疼痛程度会影响ART结果吗？

OBJECTIVE

目的

To evaluate if severe endometriosis-related painful symptoms impact Assisted Reproductive Technology (ART) live birth rates.

评估严重的子宫内膜异位症相关疼痛症状是否影响辅助生殖技术（ART）的活产率。

MATERIALS AND METHODS

材料和方法

Prospective observational cohort study at a university hospital. Consecutive infertile endometriosis patients who underwent ART between October 2014 and October 2021. Diagnosis of endometriosis was based on published imaging criteria using transvaginal sonography and magnetic resonance imaging, and histologically confirmed in women who had a previous history of endometriosis surgery (n=127, 35.9%). The intensity of painful symptoms related to dysmenorrhea (DM), dyspareunia (DP), noncyclic chronic pelvic pain, gastrointestinal (GI) pain, or lower urinary tract pain was evaluated using a 10-cm Visual Analogue Scale (VAS), before ART. Severe pain was defined as having a VAS of 7 or higher for at least one symptom. The main outcome measure was the cumulative live birth rate (CLBR) per patient. We analyzed the impact of endometriosis-related painful symptoms on ART outcomes using univariable and multivariate analysis.

在一所大学医院进行的前瞻性观察性队列研究。纳入了在2014年10月至2021年10月期间接受ART治疗的连续不孕症子宫内膜异位症患者。子宫内膜异位症的诊断基于经阴道超声和磁共振成像的已发表的影像学标准，并在有先前子宫内膜异位症手术史的女性中进行了组织学确认（n=127，35.9%）。在ART治疗前，使用10厘米视觉模拟评分（VAS）评估与痛经（DM）、性交疼痛（DP）、非周期性慢性盆腔疼痛、胃肠道疼痛或下尿路疼痛相关的疼痛症状的强度。严重疼痛被定义为至少一种症状的VAS评分达到7或更高。主要结果指标是每位患者的累计活产率（CLBR）。我们使用单变量和多变量分析来分析子宫内膜异位症相关疼痛症状对ART结果的影响。

RESULTS

结果

Three hundred and fifty-four endometriosis patients underwent 711 ART cycles. The mean age of the population was 33.8 ± 3.7 years, and the mean duration of infertility was 3.6 ± 2.1 years. The distribution of the endometriosis phenotypes was: superficial endometriosis, 3.1%; ovarian endometrioma, 8.2%; deep infiltrating endometriosis, 88.7%. The mean VAS scores for DM, DP and GI pain symptoms were: 6.6 ± 2.7, 3.4 ± 3.1, and 3.1 ± 3.6, respectively. The CLBR per patient was 63.8% (226/354). Neither the mean VAS scores for the different painful symptoms, nor the proportion of patients displaying severe pain significantly differed between patients who had a live birth and those who had not using univariate and multivariate analysis (OR = 1.34, 95%CI (0.79-2.27)), p = 0.285). The only significant factors associated with negative ART outcomes were the age > 35 years (p < 0.001), the AMH levels < 1.2 ng/mL (p < 0.001) and a previous history of surgery for endometrioma (p = 0.026).

354名子宫内膜异位症患者接受了711个ART周期。其平均年龄33.8±3.7岁，平均不孕持续时间3.6±2.1年。子宫内膜异位症的表型分布为：浅表性子宫内膜异位症（3.1%）、卵巢型（8.2%）、深部浸润型（88.7%）。其中痛经、性交痛、胃肠道疼痛的VAS评分分别为6.6±2.7, 3.4±3.1和3.1±3.6分。每位患者的CLBR为63.8%(226/354)。使用单因素和多因素分析后发现有活产结局的患者和非活产患者的不同疼痛症状的平均VAS评分和表现严重疼痛的患者比例均无显著差异(OR =1.34, 95%CI (0.79-2.27)，p=0.285)。此外，本次研究发现与该人群不良ART结局结果相关的显著因素有：年龄> 35岁(p < 0.001)，AMH水平< 1.2 ng/mL (p < 0.001)，既往有子宫内膜异位囊肿手术史(p = 0.026)。

CONCLUSIONS

结论

Severe pain symptoms are not associated with reduced ART live birth rates.

子宫内膜异位症患者是否有剧烈疼痛症状不影响辅助生殖技术结果。

IMPACT STATEMENT

影响声明

Endometriosis-related pain should not be a reason to systematically refer infertile women to surgery, if the medical treatment alleviates painful symptoms.

如果医疗治疗能缓解疼痛症状，子宫内膜异位症相关的疼痛不应成为将不孕妇女系统性地推荐手术的理由。

文章来源：

ENDOMETRIOSIS: SEVERE PAIN SYMPTOMS DO NOT IMPACT ART (ASSISTED REPRODUCTIVE TECHNOLOGY) OUTCOMES Maignien, Chloé et al.Fertility and Sterility, Volume 120, Issue 4, e295