Different Outcomes of Pelvic Inflammatory Disease after Transvaginal Oocyte Retrieval in Patients with and without Endometriosis and the Factors Influencing Its Treatment: A Retrospective Study of 66 Cases

Wei Zhao^1,†, Ruizhe Chen^1,†, Fang Le¹, Xijing Chen¹, Xinyun Yang¹, Huijuan Gao¹, Hangying Lou^1,*, Yimin Zhu¹

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¹ Department of Reproductive Endocrinology, Zhejiang University School of Medicine Women's Hospital, 310000 Zhejiang, China

^*Correspondence: louhangying888@zju.edu.cn (Hangying Lou)
^†These authors contributed equally.
Academic Editor: Andrea Tinelli

Clin. Exp. Obstet. Gynecol. 2022, 49(6), 139; https://doi.org/10.31083/j.ceog4906139

Submitted: 26 January 2022 | Revised: 9 March 2022 | Accepted: 14 March 2022 | Published: 10 June 2022

This is an open access article under the CC BY 4.0 license.

Abstract

Background: Even though endometriosis is an important risk factor for pelvic inflammatory disease (PID), it is still not clear whether endometriosis influences PID after ultrasound-guided transvaginal oocyte retrieval (TVOR). Therefore, this work was designed to explore whether endometriosis will influence PID after TVOR and study the influencing factors of receiving drainage treatment to improve the outcomes of patients with PID. Methods: A retrospective study was conducted between 2004 and 2017. Data were collected from Women’s Hospital, Zhejiang University School of Medicine, China. This study included 66 patients with acute PID symptoms after TVOR with or without endometriosis. The independent factors predicting drainage treatment were determined using univariate and multivariate logistic regression analyses, and their optimal cut-off points were ascertained using a receiver operating characteristic curve. Results: Among 66 cases, there were 53 women without endometriosis and 13 women with stage III or IV endometriosis. The significantly higher maximum body temperature (p = 0.047), longer days of fever (p = 0.043) and duration of intravenous (IV) antibiotic use (p = 0.001), and more receiving drainage treatment (p = 0.002) were found in the patients with endometriosis. In vitro fertilization (IVF) cycles (odds ratio [OR] = 6.055, 95% confidence interval [CI] = 1.360–26.961, p = 0.018), puncture cyst during TVOR (OR = 60.167, 95% CI = 2.477–1461.619, p = 0.012), and pre-treatment C-reactive protein (CRP; OR = 1.022, 95% CI = 1.003–1.041, p = 0.022) were significant independent risk factors for drainage treatment. The optimal cut-off for IVF cycles and pre-treatment CRP for patients receiving drainage treatment were 2 and 40.3 mg/L, respectively. Conclusions: Patients with endometriosis had more severe PID outcomes after TVOR, requiring more attention during treatment. Early drainage treatment is recommended for patients with pre-treatment CRP levels higher than 40.3 mg/L, puncture cyst during TVOR, and those receiving more than 2 IVF cycles.

Keywords

in vitro fertilization

endometriosis

transvaginal oocyte retrieval

pelvic inflammatory disease

drainage treatment

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Fig. 1.

The ROC curves compared the performance of IVF cycles, puncture cyst during TVOR, pre-treatment CRP and the joint predictor in the prediction of patients receiving drainage treatment. *Significant differences (p $<$ 0.05) of the AUC of the independent factors and joint predictor. ROC, receiver–operating characteristic; TVOR, transvaginal oocyte retrieval; AUC, area under the curve; CRP, C-reactive protein; IVF, in vitro fertilization.

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Clin. Exp. Obstet. Gynecol. Print ISSN 0390-6663 Electronic ISSN 2709-0094