Uterine polyps, adenomyosis, leiomyomas, and endometrial receptivity
Uterine polyps, adenomyosis, leiomyomas, and endometrial receptivity
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DOI：
10.1016/j.fertnstert.2019.02.008
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发表时间：
2019-04-01
影响因子：
6.7
通讯作者：
Munro, Malcolm G.
中科院分区：
文献类型：
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作者：
Munro, Malcolm G.
子宫内膜息肉、子宫腺肌病和平滑肌瘤是育龄妇女和不孕妇女中常见的异常现象。临床医生经常面临的挑战是确定这些实体中哪些实体一旦发现可能会损害生育能力，哪些是与当前问题无关的“无辜旁观者”。虽然切除子宫内膜息肉可能被视为相对良性和安全的干预措施，但子宫肌瘤切除术，特别是子宫腺肌瘤切除术，可能是实质性的外科手术，与其本身破坏生育能力的可能性有关。当这些实体导致不孕时，被认为涉及的机制之一是对子宫的不利影响。事实上，息肉、子宫腺肌病和子宫肌瘤都与子宫内膜分子表达异常的可能性增加有关，这些异常子宫内膜分子表达被认为会损害植入和早期胚胎发育。这篇综述旨在研究这些常见实体与子宫内膜容受性的关系，并确定在制定研究计划时应考虑的证据差距。我们可能必须认识到单独成像的局限性，并寻求基于证据的分子分析，以提供针对患者特定治疗决策所需的个体化疾病表型（(C) 2019，美国生殖医学会。）
Endometrial polyps, adenomyosis, and leiomyomas are commonly encountered abnormalities frequently found in both fertile women and those with infertility. The clinician is frequently challenged to determine which of these entities, when found, is likely to impair fertility, and which are "innocent bystanders'' unrelated to the problem at hand. Although removing an endometrial polyp may be seen as a relatively benign and safe intervention, myomectomy, and in particular adenomyomectomy, can be substantive surgical procedures, associated with their own potential for disrupting fertility. One of the mechanisms thought to be involved when these entities are contributing to infertility is an adverse impact on endometrial receptivity. Indeed polyps, adenomyosis, and leiomyomas have all been associated with an increased likelihood of abnormal endometrial molecular expressions thought to impair implantation and early embryo development. This review is designed to examine the relationship of these common entities to endometrial receptivity and to identify evidence gaps that should be considered when strategizing research initiatives. It is apparent that we have the tools necessary to fill these gaps, but it will be necessary to approach the issue in a strategic and coordinated fashion. It is likely that we will have to recognize the limitations of imaging alone and look to the evidence-based addition of molecular analysis to provide the individualized phenotyping of disease necessary for patient-specific treatment decisions. ((C) 2019 by American Society for Reproductive Medicine.)