Эндометриоз-ассоциированное бесплодие. Клинико-анамнестические особенности

Abstract

Study Objective: To compare clinical and anamnestic characteristics of women with endometriosis-associated (EAI) and tuboperitoneal (TPI) infertility. Study Design: Retrospective case–control study. Materials and Methods. The study enrolled 300 patients: 150 women with histologically confirmed EAI formed group I (study group), and 150 women with TPI who formed group II (controls). All subjects underwent clinical, anthropometric and specialised pelvic examination, laparoscopy and hysteroscopy in accordance with commonly used methods. The revised classification developed by the American Fertility Society (R-AFS) was used to evaluate the endometriosis severity and adhesive process prevalence. Pain intensity was evaluated using a visual analogue scale. All patients with endometriosis had their minimal preserved function and Endometriosis Fertility Index (EFI) calculated. Study Results. Patients with EAI were older that patients with TPI (31 vs 29 years old, p = 0.002); they more frequently had pelvic pain (41.3%), dysmenorrhea (29.3%), dyspareunea (31.3%), abnormal uterine bleedings (12.7%) were reported only by patients with EAI (р = 0.001 in all cases). Endometriosis in these patients was localised primarily on the pelvic peritoneum, uterine ligaments and ovaries. Endometriosis stage I–II was recorded in 57% of patients with EAI, stage III and IV — in 43%; and no relationship has been found between disease stage and clinical signs of the disease. The minimal mean preserved function in patients with EAI was 12.8 ± 5.6 points, EFI — 6.7 ± 2.6 points. Endometriosis was diagnosed and verified late, at an average of 3 years after onset of symptoms. Conclusion. Patients with EAI had some peculiar clinical and anamnestic characteristics vs. patients with TPI. Despite the fact that endometriosis was diagnosed and verified at an average of 3 years after onset of symptoms, EFI shows that the efficiency of surgery for infertility management is quite high in this group of patients. Further studies are required to evaluate the need in and the timing of laparoscopy in this category of patients. Keywords: endometriosis, infertility, endometriosis-associated infertility, tuboperitoneal infertility.