중증 자궁내막증의 수술적 치료 후 체외수정의 결과 = In vitro fertilization outcomes in patients with advanced endometriosis after surgical treatment중증 자궁내막증의 수술적 치료 후 체외수정의 결과

다국어 초록 (Multilingual Abstract)

Objective: The aim of this study is to evaluate in vitro fertilization (IVF) outcomes in advanced endometriosis with/without surgical treatment and to compare between cyst enucleation and surgically treated peritoneal lesions without endometrioma. Methods: We performed a retrospective analysis of 506 IVF cycles (345 patients) with stage III-IV endometriosis (170 cycles without surgical treatment, 336 cycles with the surgical treatment) between 1997 and 2004. Among the surgical treatment, 151 cycles were performed previously cyst enucleation with endometrioma and 185 cycles were performed only resection of peritoneal lesions without endometrioma enucleation. 313 cycles (246 patients) with the tubal factor infertility were used as controls. Results: In the endometriosis group with/without surgical treatment, the number of retrieved oocytes (9.6±7.3 vs. 11.2 ± 7.5 vs. 14.8 ± 7.0, P < 0.0001) and the transferred embryos (3.5 ± 1.4 vs. 3.5 ± 1.4 vs. 3.9 ± 0.9, P = 0.001) was significantly lower than controls. But, implantation rates (17.2% vs. 15.2% vs. 15.9%), pregnancy rates (36.9% vs. 35.9% vs. 39.6%) and live birth rates (32.1% vs. 28.2% vs. 29.7%) were similar. Surgically treated peritoneal lesions group showed no difference in the number of retrieved oocytes (9.6 ± 7.9 vs. 9.8 ± 6.5), the number of transferred embryos (3.4 ± 1.4 vs. 3.7 ± 1.3), implantation rates (15.5% vs. 18.0%), pregnancy rates (34.6% vs. 39.7%) and live birth rates (29.2% vs. 35.8%) with cyst enucleation group. Conclusion: IVF parameters in the patients with endometriosis are inferior to tubal factor infertility, but IVF outcomes are comparable. Surgically treated peritoneal lesions group without endometrioma enucleation shows IVF parameters as bad as cyst enucleation group. We might be considered endometriosis itself worse IVF parameters regardless previous cyst enucleation.