Effect of gonadotropin-releasing hormone analogue on pregnancy outcome of endometriosis infertility patients after laparoscopic surgery

Hongxia Zhang, Xia Liu, Liping Wang, Wei-ping Fu, Qin Zhu
In: BMJ · 2015 · vol. 14(9) , pp. 678–681 · doi:10.3760/cma.j.issn.1671-7368.2015.09.006 · W3032318673
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⚙ AI-generated summary by claude@2026-06, 2026-06-11 ⓘ

Three cycles of GnRH-a treatment improved the pregnancy rate within one year and reduced the abortion rate in endometriosis infertile patients after laparoscopic surgery.

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This paper studied whether long-acting gonadotropin-releasing hormone analogue (GnRH-a) given for three cycles after laparoscopic surgery affects pregnancy outcomes in 184 patients with endometriosis-related infertility who were randomized to either GnRH-a followed by trying to conceive or direct trying to conceive. Outcomes were followed for 1–36 months (median 14 months) and analyzed overall and by endometriosis fertility index (EFI) strata (EFI 6–10 vs 0–5), with cumulative pregnancy rate and abortion rate compared between groups; the authors explicitly note differences across timepoints. Cumulative pregnancy was lower in the first 6 months in the GnRH-a group and its EFI high-fertility subgroup than in corresponding controls, but higher at 12–36 months, while Kaplan–Meier analysis found no significant differences in cumulative pregnancy rate between groups; median time to gestation was shorter with GnRH-a, and abortion rate was lower (11% vs 26%). This paper is centrally about endometriosis — it tests GnRH-a treatment after laparoscopic surgery in endometriosis infertility patients and reports effects on postoperative pregnancy and abortion outcomes.

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Abstract

Objective To investigate the effect of gonadotropin-releasing hormone analogue(GnRH-a)on pregnancy outcome in patients with endometriosis infertility after laparoscopic surgery. Methods Two hundred and twenty two patients treated with laparoscopic surgery for endometriosis infertility in Jiaxing Maternal and Child Health Care Hospital between January 2010 and December 2012 were enrolled and 184 patients completed the study. Patients were randomly assigned to two groups: 110 patients in GnRH-a group received long-acting GnRH-a (3.75 mg injection every 28 d for 3 times) before trying to conceive, 74 patients in control group were directly trying to conceive for 1 to 36 months. According to endometriosis fertility index (EFI), patients were further subgrouped: GnRH-a group 1 (EFI scores=6-10, n=83), GnRH-a group 2 (EFI scores=0-5, n=27), control group 1 (EFI scores=6-10, n=55) and control group 2 (EFI scores=0-5, n=19). The cumulative pregnancy rate (CPR)and abortion rate were compared among groups and subgroups. Results The patients were followed up for 1 to 36 months after trying to conceive, with a median follow-up time of 14 months. The total CPR was 62% (114/184), the median time for gestation was 11 months. Within the first 6 months after operation, the CPR in GnRH-a group and its subgroups were lower than those in corresponding control groups, with significant difference between GnRH-a group and control group [9%(10/110) vs. 32%(24/74), χ2=16.00, P 0.05]. Kaplan-Meier analysis showed that there were no significant difference in CPR between GnRH-a group and control group, GnRH-a group 1 and control group 1, GnRH-a group 2 and control group 2 (all P>0.05). The median time for gestation in GnRH-a group and its subgroups were shorter than those in corresponding control group. The median time for gestation in GnRH-a group was 10 (95%CI: 8.2-11.8) months and that in control group was 17 (95%CI: 11.8-22.1) months. The abortion rate in GnRH-a group and control group was 11% (7/72) and 26% (11/42), respectively (χ2=4.34, P<0.05). Conclusion Administration of GnRH-a for 3 cycles can improve postoperative pregnancy rate within 1 year and reduce the abortion rate for endometriosis infertile patients after laparoscopic surgery especially for these with strong fertility. Key words: Endometriosis; Pregnancy; Gonadotropin-releasing hormone; Treatment outcome
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促性腺激素释放激素激动剂对子宫内膜异位症不孕患者腹腔镜术后妊娠的作用 Effect of gonadotropin-releasing hormone analogue on pregnancy outcome of endometriosis infertility patients after laparoscopic surgery 摘要目的 探讨宫内膜异位症(EMs)不孕症患者腹腔镜术后应用促性腺激素释放激素激动剂(GnRH-a)对妊娠结局的影响.方法 对2010年1月至2012年12月在嘉兴市妇幼保健院因EMs不孕行腹腔镜手术后要求试孕患者222例,随机分组后完成规范治疗184例,其中1 10例应用长效GnRH-a治疗(每次3.75 mg,每28天注射1次,共3次)后试孕(GnRH-a组),74例直接试孕(对照组),术后试孕1 ～ 36个月.GnRH-a组中,EMs生育指数(EFI)为6～10分者83例(GnRH-a1组),EFI为0～5分者27例(GnRH-a2组);对照组中,EFI为6～10分者55例(对照1组),EFI为0～5分者19例(对照2组).结果 随访1～36个月,中位随访14个月.总累积妊娠率62％ (114/184),中位妊娠时间11个月.术后6个月累积妊娠率:GnRH-a组及其亚组累积妊娠率均低于对应对照组,其中GnRH-a组低于对照组9％(10/110)与32％ (24/74)、GnRH-a1组低于对照1组8％(7/83)与38％(21/55),差异有统计学意义(x2 =16.00,P＜0.01;x2=18.10,P＜0.01).术后12、24及36个月累积妊娠率:GnRH-a组及其亚组累积妊娠率均高于对应对照组,其中术后12个月时GnRH-a 1组与对照1组比较66％(55/83)与49％(27/55)差异有统计学意义(x2 =4.05,P＜0.05).GnRH-a组1年内妊娠比例88％(63/72)高于对照组76％ (32/42),差异无统计学意义(x2=2.44,P＞0.05).Kaplan-Meier生存分析累积妊娠率,GnRH-a组及其亚组与对应对照组比较,差异均无统计学意义(log-rank x2值分别为0.59、0.31和0.70,均P＞0.05),GnRH-a组及其亚组中位妊娠时间短于对应对照组,其中GnRH-a组中位妊娠时间(95％ CI)为10(8.2～11.8)个月,对照组为17(11.8～22.1)个月.GnRH-a组流产率11％ (8/72)低于对照组的26％ (11/42),差异有统计学意义(x2=4.34,P＜0.05).结论 EMs不孕患者尤其是生育力高的患者术后应用GnRH-a治疗3个周期可提高术后1年妊娠率,降低流产率. 更多相关知识 abstractsObjective To investigate the effect of gonadotropin-releasing hormone analogue(GnRH-a) on pregnancy outcome in patients with endometriosis infertility after laparoscopic surgery.Methods Two hundred and twenty two patients treated with laparoscopic surgery for endometriosis infertility in Jiaxing Maternal and Child Health Care Hospital between January 2010 and December 2012 were enrolled and 184 patients completed the study.Patients were randomly assigned to two groups:110 patients in GnRH-a group received long-acting GnRH-a (3.75 mg injection every 28 d for 3 times) before trying to conceive,74 patients in control group were directly trying to conceive for 1 to 36 months.According to endometriosis fertility index (EFI),patients were further subgrouped:GnRH-a group 1 (EFI scores =6-10,n =83),GnRH-a group 2 (EFI scores =0-5,n =27),control group 1 (EFI scores =6-10,n =55) and control group 2 (EFI scores =0-5,n =19).The cumulative pregnancy rate (CPR) and abortion rate were compared among groups and subgroups.Results The patients were followed up for 1 to 36 months after trying to conceive,with a median follow-up time of 14 months.The total CPR was 62％ (114/184),the median time for gestation was 11 months.Within the first 6 months after operation,the CPR in GnRH-a group and its subgroups were lower than those in corresponding control groups,with significant difference between GnRH-a group and control group [9％ (10/110) vs.32％ (24/74),x2 =16.00,P ＜0.01],GnRH-a group 1 and control group 1 [8％ (7/83) vs.38％ (21/55),x2 =18.10,P ＜0.01].Within 12 months,24 months and 36 months,the CPR in GnRH-a group and its subgroups were all higher than those in corresponding control groups [66％ (55/83) vs.49％ (27/55),x2 =4.05,P ＜ 0.05].The pregnant rate within 12 months in GnRH-a group was 88％ (63/72),which was not significantly different to that in control group [76％ (32/42),x2 =2.44,P ＞ 0.05].Kaplan-Meier analysis showed that there were no significant difference in CPR between GnRH-a group and control group,GnRH-a group 1 and control group 1,GnRH-a group 2 and control group 2 (all P ＞ 0.05).The median time for gestation in GnRH-a group and its subgroups were shorter than those in corresponding control group.The median time for gestation in GnRH-a group was 10 (95％ CI:8.2-11.8) months and that in control group was 17 (95％ CI:1l.8-22.1) months.The abortion rate in GnRH-a group and control group was 11％ (7/72) and 26％ (11/42),respectively (x2 =4.34,P ＜ 0.05).Conclusion Administration of GnRH-a for 3 cycles can improve postoperative pregnancy rate within 1 year and reduce the abortion rate for endometriosis infertile patients after laparoscopic surgery especially for these with strong fertility. More相关知识 - 浏览245 - 被引20 - 下载112 相似文献 - 中文期刊 - 外文期刊 - 学位论文 - 会议论文

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