The Risk of Infertility After Surgery for Benign Ovarian Cysts.
The Risk of Infertility After Surgery for Benign Ovarian Cysts.
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良性卵巢囊肿手术后不孕的风险。
DOI：
10.1089/jwh.2022.0385
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Howards,PenelopeP
中科院分区：
文献类型：
--
作者：
Shandley,LisaM;Spencer,JessicaB;Kipling,LaurenM;Hussain,Banna;Mertens,AnnC;Howards,PenelopeP
背景：越来越多的证据表明卵巢囊肿切除术可能对卵巢储备产生负面影响。然而，目前尚不清楚卵巢囊肿手术是否会增加女性未来不孕的风险。本研究探讨良性卵巢囊肿手术是否与长期不孕风险相关。方法：对年龄22-45岁的女性1537人进行生殖史访谈，包括是否有过不孕或卵巢囊肿手术。每个报告囊肿手术的妇女被随机匹配到一个比较妇女，该比较妇女被分配一个与她匹配的人工手术年龄相等的年龄。匹配重复了1000次。校正Cox模型适合于检查每个配型的术后不孕时间。一部分女性被邀请参加临床访问，以评估卵巢储备标志物（抗<s:1>勒氏激素[AMH]，窦卵泡计数）。结果：大约6.1%的女性报告了囊肿手术。在调整了年龄、种族、体重指数、癌症史、手术前胎次、手术前不孕史和子宫内膜异位症等因素后，接受囊肿手术的女性术后不孕比未接受手术的女性更常见（调整后中位风险比2.41,95%模拟区间1.03-6.78）。有卵巢囊肿手术史的女性AMH水平的几何平均值（95%置信区间[CI]）是无手术史女性的1.08倍（95% CI: 0.57-2.05）。结论：有卵巢囊肿手术史的女性与没有囊肿手术史的同龄女性相比，更有可能报告有不孕史。卵巢切除囊肿的手术和导致女性囊肿需要手术的条件可能会影响随后的成功受孕。
Background:There is a growing body of evidence that ovarian cystectomy may negatively impact ovarian reserve. However, it is unclear whether ovarian cyst surgery puts women at risk of future infertility. This study investigates whether surgery for benign ovarian cysts is associated with long-term infertility risk.Methods:Women aged 22–45 years (n= 1,537) were invited to participate in an interview about their reproductive histories, including whether they ever had infertility or ovarian cyst surgery. Each woman reporting cyst surgery was randomly matched to a comparison woman, who was assigned an artificial surgery age equal to that of her match. Matching was repeated 1,000 times. Adjusted Cox models were fit to examine time to infertility after surgery for each match. A subset of women was invited to participate in a clinic visit to assess markers of ovarian reserve (anti-Müllerian hormone [AMH], antral follicle count).Results:Approximately 6.1% of women reported cyst surgery. Infertility after surgery was more common for women reporting cyst surgery than those without surgery after adjusting for age, race, body mass index, cancer history, parity before assigned surgery age, history of infertility before surgery age, and endometriosis (median-adjusted hazard ratio 2.41, 95% simulation interval 1.03–6.78). The estimated geometric mean (95% confidence interval [CI]) AMH levels of those who reported a history of ovarian cyst surgery were 1.08 (95% CI: 0.57–2.05) times those of women who reported no history of surgery.Conclusions:Those with a history of ovarian cyst surgery were more likely to report having a history of infertility compared with age-matched women who reported no history of cyst surgery. It is possible that both ovarian surgery to remove cysts and the conditions that lead women to develop cysts requiring surgery may affect subsequent successful conception.
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