Objective To select appropriate therapeutic modalities to improve the reproductive outcome and delay relapse in patients with severe endometriosis and infertility. Methods Clinical data of 81 patients with stage III -IV endometriosis and infertility were retrospectively reviewed. Among those patients, 4 were treated with conservative surgery alone (group A), 28 were treated with gonadotropin-releasing hormone agonist (GnRHa) for 3 to 6 months after a conservative surgery (group B) , 6 were treated with in vitro fertilization - embryo transfer (IVF-ET) after a conservative surgery (group C) , 8 treated with IVF-ET directly without surgery (group D) , 35 were treated with GnRHa for 3 to 6 months after a conservative surgery, then underwent IVF-ET (group E). The recurrence and pregnant outcomes were compared after a median follow-up of 48.2±3.8months. Results The pregnancy rate in D and E groups was significantly higher than that in A and B groups (P= 0.038.P = 0.02). The live birth rate of ovulation pregnancy in E group was higher than that in C and D groups (P= 0.048). The recurrence rate in E group was much lower than other groups (P<0.05) and the duration of recurrence in C and E groups was longer than that in A and B groups (P <0.05). Conclusion Surgery plays a limited role in improving reproductive outcome in patients with severe endometriosis and infertility, but GnRHa treatment with IVF-ET after conservative surgery can improve the pregnancy rate.%目的 探讨重度子宫内膜异位症(EMS)合并不孕的患者如何选择合适的治疗方案以改善生育结局及延缓复发.方法 对2005至2010年期间收住的重度EMS合并不孕患者的临床资料进行回顾性分析,81例患者按不同的治疗方案分为5组:A组,单纯行保守性手术(术后未用药),4例;B组,保守性手术后予促性腺激素释放激素激动剂(GnRHa)治疗3～6个月,28例;C组,保守性手术后予体外受精-胚胎移植(IVF-ET)治疗,6例;D组,未行手术直接行IVF-ET治疗,8例;E组,保守性手术后予GnRHa治疗3～6个月后行IVF-ET治疗,35例,拟比较各治疗方案患者间的生育结局.结果 D、E组的妊娠率明显高于A、B组(均P＜0.05).E组促排卵妊娠后的活产率高于C、D组(P＜0.05).E组的复发率明显低于其它组(P＜0.05),C、E组的复发时间较A、B组迟(均P＜0.05).结论 手术改善重度EMS合并不孕患者生育结局的作用有限,但术后长周期的GnRHa+辅助生育治疗能提高妊娠率.
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