(BMI)=18.0~24.9 kg/m 2 ;

33 10 Vol.33 No.10 2013 10 Oct. 2013 Reproduction & Contraception doi: 10.7669/j.issn.0253-357X.2013.10.0672 E-mail: randc_journal@163.com - ( 400013) : () GnRH-a - () : IVF- ET 233 A (I~II 102 ) B (III~IV 131 ) : FSH (bfsh) (P>0.05) B A (P< 0.01) (Gn) hcg Gn (P>0.05) (P>0.05) (60.64% vs 62.18%)(P>0.05) : : (); - (); (COS); : R711.6 : A : 0253-357X(2013)10-0672-05 (endometriosis ) - (in vitro fertilization-embryo transfer ) (gonadotropin release hormone agonist GnRH-a) GnRH-a : 2011-2-303 : ; Tel: +86-23-63846879; Fax: +86-23-63839850; E-mail: angelicadeng@aliyun.com 1 1.1 2010.01~2012.06 IVF : <35 ; ; (bfsh<10 miu/ml be2<50 pg/ml) [1] ; (BMI)=18.0~24.9 kg/m 2 ; ; (25~35 d); (rafs)1985 672

60 mg/d 10~12 I ( ) II ( ) III ( ) IV ( ) I~II A III~IV B 1.2 1.2.1 GnRH-a GnRH-a( Diphereline 3.75 mg/ ) 3 2~5 (AFC) 1 GnRH-a 28 56 2 3 3 28~50 [ <5 mm <5 mm (FSH)<5 miu/ml (LH)<5 miu/ml (E2)<30 pg/ml] (gonadotropin Gn) 1.2.2 Gn Gn (r-fsh Gonal-F 75 IU/ ) (hmg 75 IU/ ) B (E2 P LH FSH) 3 18 mm (rhcg )250 μg 35~37 h B 1.2.3 IVF/ICSI(intracytoplasmic sperm injection) : 2 4~5 3 7 <20% : 3 4 <50% 72 h B <7 mm (ovarian hyperstimulation syndrome OHSS) OHSS OHSS 1.2.4 ( )80 mg/d 60 mg/d 14 d / β-hcg : 14 d β-hcg β-hcg>25 miu/ml [2] 28~35 d B 1.3 SPSS17.0 (x s) t χ 2 P<0.05 2 2.1 233 A 102 B 131 BMI FSH(bFSH) AFC (P>0.05); B ( ) A (P<0.01) 1 1 (x s %) Table 1 Basic characteristics of patients n 102 131 ( )Age (year) 30.4 2.9 30.4 2.7 (a) 5.6 3.4 5.3 2.9 Duration of infertility BMI (kg/m 2 ) 20.88 2.04 21.04 2.35 Type of infertility Primary Secondary 48.04 (49/102) 51.96 (53/102) 50.38 (66/131) 49.62 (65/131) (a) 2.4 1.6 2.3 1.8 Years to last surgery (n) 1.2 0.4 1.3 0.5 Surgery times bfsh (miu/ml) 5.69 1.27 5.78 1.40 AFC Basal AFC (n) 9.6 3.7 9.3 4.2 Previous surgery of ovarian endometrioma Unilateral Bilateral None 34.32 (35/102) * 11.76 (12/102) * 53.92 (55/102) 46.56 (61/131) 25.19 (33/131) 28.25 (37/131) *: P<0.01 B compared with group B 673

2.2 A 102 (controlled ovarian stimulation COS) 3 1 2 OHSS 2 94 B 131 COS 5 2 3 OHSS 2 119 COS (2.94% vs 3.82%) (P>0.05) 2.3 COS 2 Gn hcg (E2 P LH FSH) (P>0.05) Gn B Gn A (P>0.05) Gn hcg M II M II M II ( ) ( ) (P>0.05) 2.4 ET (P>0.05) (P>0.05) 3 3 3.1 [3] [4] [5] 3.2 [6] ( ) 2 COS (x s %) Table 2 Data of COS cycles n 102 131 Gn Gn launch day E2 (pg/ml) P (ng/ml) LH (miu/ml) FSH (miu/ml) 11.74 0.19 0.34 3.79 3.71 0.11 0.27 1.60 12.88 0.21 0.32 3.70 5.61 0.10 0.30 1.22 hcg hcg injection day E2 (pg/ml) P (ng/ml) 1 634.17 0.62 1 098.39 0.41 1 592.66 0.57 943.44 0.33 LH (miu/ml) FSH (miu/ml) (mm) 0.62 13.54 10.89 0.71 4.40 1.63 0.55 13.17 11.00 0.43 4.40 1.50 Endometrial thickness Gn (IU) 235.7 56.0 240.3 52.2 Doses of Gn on launch day Gn (IU) 2 598.0 748.1 2 711.9 777.4 Total doses of Gn used Gn (d) 10.8 1.4 11.18 1.88 Days of Gn used (n) No. of follicles (n) No. of oocytes retrieved 9.0 7.9 4.4 4.6 8.6 7.5 5.4 4.3 MII (n) 6.3 4.0 6.1 3.9 No. of MII oocyte number MII MII oocyte rate MII 80.18 (623/777) 82.02 (771/940) 85.71 (534/623) 86.90 (670/771) Fertilization rate of MII oocytes Cleavage rate 97.38 (520/534) 96.27 (645/670) (n) 3.4 2.6 3.5 1.7 No. of transferable embryos 63.27 (329/520) 66.67 (430/645) Transferable embryo rate 21.73 (113/520) 23.72 (153/645) Good-quality embryo rate (n) 1.2 1.2 1.2 1.1 No. of good-quality embryos Coccia [6] I~II IVF I~II III~IV 674

3 (x s %) Table 3 Clinical outcomes of embryo transfer (ET) cycles of patients ET (n) 94 119 ET cycle number (n) 1.9 0.6 2.0 0.3 No. of embryos transferred Implantation rate Clinical pregnancy rate Abortion rate Ectopic pregnancy rate 46.59 (82/176) 65.96 (62/94) 6.45 (4/62) 1.61 (1/62) 60.64 (57/94) 49.37 (117/237) 68.91 (82/119) 8.54 (7/82) 1.22 (1/82) 62.18 (74/119) Live birth rate per ET cycle IVF [11] [1213] [14] : [15] / AFC (P>0.05) [16] hcg E2 III~IV 3.3 GnRH-a GnRH-a FSH LH GnRH GnRH-a GnRH-a LH [7] IVF 2~3 GnRH-a GnRH-a ART [8] [9] 3.4 [10] [17] B (III~IV ) ( ) IVF B COS Gn hcg Gn B Gn A Gn hcg M II / M II / / ET 675

( ) ART [1]... : 2012:109. [2].. 2009 17 (10):112-4. [3] Christodoulakos G Augoulea A Lambrinoudako I et al. Pathogenesis of endometriosis: the role of defective immunosurveillance. Eur J Contracep Reprod Health Care 2007 12(3):194-202. [4] Kalu E Sumar N Giannopoulos T et al. Cytokine P profiles in serum and peritoneal fluid from infertile women with and without endometriosis. J Obstet Gynaecol Res 2007 33(4): 490-5. [5] Minici F Tiberi F Tropea A et al. Endometriosis and human infertility: a new investigation into the role of eutopic endometrium. Hum Reprod 2008 23(3):530-7. [6] Coccia ME Rizzello F Mariani G et al. Impact of endometriosis on in vitro fertilization and embryo transfer cycles in young women: a stage-dependent interference. ACTA Obstet Gynecol 2011 90(11):1232-8. [7] Ma C Qiao J Liu P et al. Ovarian suppression treatment prior to in-vitro fertilization and embryo transfer in Chinese women with stage or endometriosis. Int J Gynaecol Obstet 2008 100(2):167-70. [8]. -. 2009 18(3):205-7. [9]. GnRH-a -. 2012 41(4):333-5. [10] Suzuki T Izumi S Matsubayashi H et al. Impact of ovarian emdometrioma on oocytes and pregnancy outcome in in vitro fertilization. Fertil Steril 2005 83(4):908-13. [11] Exacoustos C Zupi E Amadio A et al. Laparoscopic removal of endometriomas: sonographic evaluation of residual functioning ovarion tissue. Am J Obstet Gynecol 2004 191(1): 68-72. [12] Alborzi S Ravanbakhsh R Parsanezhad ME et al. A comparison of follicular response of ovaries to ovulation induction after laparoscopic ovarian cystectomy or fenestration and coagulation versus normal ovaries in patients with emdometrioma. Fertil Steril 2007 88(2):507-9. [13]. -. 2009 44(1):60-2. [14] Busacca M Riparin J Somigliana E et al. Postsurgical ovarian failure after laparoscopic excision of bilateral endometromas. Am J Obstet Gynecol 2006 195(2):421-5. [15]. ART. 2012 32(9):630-8. [16] Carcia-Velasco JA Mahutte NG Corona J et al. Removal of endometriomas before in vitro fertilization does not improve fertility outcomes: a matched case-control study. Fertil Steril 2004 81(5):1194-7. [17] Esinler I Bozdag G Aybar F et al. Outcome of in virto fertilization/intracyto plasmic sperm injection after laparoscopic cystectomy for endometriomas. Fertil Steril 2006 85(6):1730-5. (2012 3 19 ) ( 695 refer to p695) ****************************************************************************************************************************************** 2013 12 779 : 779 : 200237 : 021-64438169 : 021-64438975 : http://www.randc.cn : randc_journal@163.com 676