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| Efficacy of hysteroscopy combined with laparoscopy for treating infertility women with endometriosis and its influence on postoperative pregnancy |
| 1. General Hospital of Central War Zone, Wuhan, Hubei Province, 430070,; 2. Xiangyang Central Hospital of Hubei Province, Affiliated Hospital of Hubei University of Arts and Sciences |
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Abstract To investigate the efficacy of hysteroscopy combined with laparoscopy for treating infertility women with endometriosis, and to study its influence on postoperative pregnancy. Methods: The clinical data of 108 infertility women with endometriosis from May 2016 to May 2017 were retrospectively analyzed. These women were divided into two groups according to different treatment schemes (51 cases in each group). The women in the control group underwent laparoscopic surgery, while the women in the study group underwent hysteroscopy combined with laparoscopy. After operation, the women in both groups were treated with gonadotropin-releasing hormone agonist (GnRH-a) on the 2nd to the 5th day after menstruation for 6 months. The intraoperative blood loss, operation time, postoperative hospital stay, pregnancy rate within postoperative 2 years, clinical efficacy, and complication rate of women were compared between the two groups. Logistic regression analysis were used to analyze the related influence factors of postoperative pregnancy. Results: There were no significant different in intraoperative blood loss, operative time, and postoperative hospital stay of women between the two groups (P＞0.05). The effective rate (96.5%) and pregnancy rate within 2 years after operation (63.2%) of women in the study group were significant higher than those (80.4% and 41.2%) of women in the control group, but the incidence of complications (3.5%) of women in the study group was significant lower than that (15.7%) of women in the control group (P＜0.05). There were no significant different in the age, BMI, infertility time, history of pelvic surgery, and postoperative pregnancy of women between the two groups (P＞0.05), but there were significant different in the different stages of endometriosis (r-AFS stage), the unblocked fallopian tube situation, the application of assisted reproductive technology, the standardized postoperative medication, and postoperative pregnancy of women after different surgical treatment scheme between the two groups (P＜0.05). Multifactor analysis showed that clinical endometrial r -AFS staging Ⅲ-Ⅳ, fallopian tube blocked, without assisted reproductive technology, without standardized postoperative medication were the risk factors of postoperative pregnancy (P＜0.05). Hysteroscopy combined with laparoscopy therapy was the protective factor of postoperative pregnancy (P＜0.05). Conclusion: Application of hysteroscopy combined with laparoscopy for treating infertility women with endometriosis can improve the postoperative pregnancy safely and effectively. r-AFS stage I-II, fallopian tube unblocked, application of assisted reproductive technology, hysteroscopy combined with laparoscopy, and standardized postoperative medication can improve the postoperative pregnancy rate.
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