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目的:探讨子宫内膜异位症（endometriosis，EMT）对行体外受精/卵胞质内单精子注射-胚胎移植（ in vitro fertilization/intracytoplasmic sperm injection and embryo transfer，IVF/ICSI-ET）治疗的不孕症患者的卵母细胞、胚胎质量及妊娠与分娩结局的影响。 方法:通过回顾性队列研究，选取于2016年1月至2023年12月期间就诊于哈尔滨医科大学附属第一医院生殖医学科行IVF/ICSI-ET治疗的EMT患者（383例，EMT组）和单纯输卵管因素的不孕症患者（1 613例，对照组），采用 1∶1倾向性评分匹配对两组患者的年龄、抗苗勒管激素水平、体质量指数、不孕类型占比、不孕年限、促排卵方案、授精方式、IVF/ICSI既往周期数进行匹配，最终纳入EMT组285例和对照组285例，分析EMT对胚胎质量及临床结局的影响。结果:①两组患者的促性腺激素（gonadotropin，Gn）使用时间、Gn使用总量、Gn启动剂量、人绒毛膜促性腺激素（human chorionic gonadotropin，hCG）注射日雌二醇黄体生成素、孕酮水平的差异均无统计学意义（均 P>0.05）。②EMT组患者的获卵总数［（7.48±5.15）枚］、MⅡ卵子数［（6.38±4.61）枚］、可移植胚胎数［（4.16±3.16）枚］、优质胚胎数［2.00（0.00，3.00）枚］、双原核（two pronuclei，2PN）优质胚胎率［42.33%（602/1 422）］均低于对照组［（8.45±4.86）枚， P=0.021；（7.32±4.43）枚， P=0.013；（4.95±3.19）枚， P=0.003；2.00（1.00，4.00）枚， P=0.002；48.76%（747/1 532）， P=0.032］，差异均有统计学意义。③两组患者新鲜周期移植和新鲜周期全胚冷冻后进行第一次解冻周期移植的临床妊娠率、胚胎种植率、早产率、早期流产率、异位妊娠率、男婴/女婴比例、分娩周数、剖宫产率的差异均无统计学意义（均 P>0.05），新鲜周期移植的EMT患者活产率［29.71%（41/138）］低于对照组［48.90%（89/182）， P=0.023］，差异具有统计学意义。④EMT不是IVF/ICSI治疗的临床妊娠率和活产率的独立影响因素，年龄、移植胚胎数是IVF/ICSI治疗的临床妊娠率和活产率的独立影响因素（ OR=0.923，95% CI：0.868~0.982， P=0.011； OR=0.890，95% CI：0.832~0.952， P=0.001； OR=2.408，95% CI：1.331~4.356， P=0.004； OR=3.838，95% CI：1.869~7.879， P<0.001）。 结论:EMT可能导致进行IVF/ICSI-ET治疗的不孕症患者的获卵总数和MⅡ卵子数减少，胚胎质量下降，但是不影响其临床妊娠结局和分娩结局。

Objective:To investigate the effect of endometriosis (EMT) on oocytes, embryo quality and pregnancy and delivery outcomes in infertility patients treated with in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET). Methods:A retrospective cohort study was conducted to select the EMT patients (383 cases, EMT group) and the infertility patients with tubal factor (1 613 cases, control group) who underwent IVF/ICSI-ET treatment in the Department of Reproductive Medicine, the First Affiliated Hospital of Harbin Medical University from January 2016 to December 2023. The cases were matched with the number of age, body mass index, anti-Müllerian hormone, proportion of infertility type, duration of infertility, ovulation stimulating therapy, insemination mode, number of previous IVF/ICSI cycles of the two groups by 1∶1 propensity score matching. Totally 285 patients with EMT and 285 patients in control group were finally included to analyze the effects of EMT on embryo quality and pregnancy outcome.Results:1) There were no statistically significant differences in the duration of gonadotropin (Gn) used, the total dosage and the initiating dosage of Gn used, and the levels of estradiol, luteinizing hormone, and progesterone on the human chorionic gonadotropin (hCG) injection day between the two groups (all P>0.05). 2) The total number of oocytes (7.48±5.15), the number of MⅡ oocytes (6.38±4.61), the number of transferable embryos (4.16±3.16), the number of high-quality embryos [2.00 (0.00, 3.00)] and the rate of two pronuclei (2PN) high-quality embryos [42.33% (602/1 422)] in EMT group were all lower than those in control group [8.45±4.86, P=0.021; 7.32±4.43, P=0.013; 4.95±3.19, P=0.003; 2.00 (1.00, 4.00), P=0.002; 48.76% (747/1 532), P=0.032], the differences were statistically significant. 3) There were no statistically significant differences in clinical pregnancy rate, embryo implantation rate, premature birth rate, early abortion rate, ectopic pregnancy rate, male/female ratio, number of weeks of delivery and cesarean section rate between the two groups with fresh cycle transplantation and with embryo freezing in fresh cycle and embryo transferred in the first resuscitation cycle (all P>0.05), the live birth rate of EMT patients with fresh cycle transplantation [29.71% (41/138)] was lower than that of control group [48.90% (89/182), P=0.023], and the difference was statistically significant. 4) EMT was not an independent factor of clinical pregnancy rate and live birth rate after IVF/ICSI treatment, but age and number of embryos transferred were independent factors of clinical pregnancy rate and live birth rate of IVF/ICSI treatment ( OR=0.923, 95% CI: 0.868-0.982, P=0.011; OR=0.890, 95% CI: 0.832-0.952, P=0.001; OR=2.408, 95% CI: 1.331-4.356, P=0.004; OR=3.838, 95% CI: 1.869-7.879, P<0.001). Conclusion:EMT may reduce the number of oocytes and MⅡ oocytes in infertility patients treated with IVF/ICSI-ET, and the quality of embryos in patients with EMT treated with IVF is worse, but it does not affect the clinical pregnancy outcome and delivery outcome in patients with EMT.