Myomas, pregnancy outcome, and in vitro fertilization
Myomas, pregnancy outcome, and in vitro fertilization
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DOI：
10.1196/annals.1335.010
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发表时间：
2004-01-01
期刊：
影响因子：
--
通讯作者：
Stefanetti, M
中科院分区：
文献类型：
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作者：
Bulletti, C;De Ziegler, D;Stefanetti, M
据报道，27%的不孕妇女患有子宫肌瘤，50%的不明原因不孕妇女在肌瘤切除术后怀孕。第一次怀孕的年龄从30多岁增加到40多岁。子宫肌瘤的复发率从15%增加到30%，这表明子宫肌瘤对不孕症的影响。肌瘤引起不孕的机制是子宫收缩力异常、宫腔延长和子宫血管扭曲。手术可能会产生有益或不利的影响，但没有明确的数据表明其对辅助生殖技术（ART）程序的影响。本研究旨在确定手术切除肌瘤对接受ART手术的患者的生育力和不孕症的影响。在体外受精前接受手术切除肌瘤的患者（A组），1至3次手术的累积成功率为33%（84例患者中有28例临床妊娠），分娩率为25%（84例患者中有21例活产）。无手术史的体外受精患者（B组）临床妊娠率为15%（84例患者中13例妊娠）（P < 0.05），分娩率为12%（84例妊娠中10例分娩）（P < 0.05）。A组和B组的流产率分别为7%（84例患者中8次分娩）和4%（84例患者中3次分娩）。这项研究证实了在接受ART手术前手术切除肌瘤的有益效果。
Uterine fibroids have been reported in 27% of infertile women, and 50% of women with unexplained infertility become pregnant after myomectomy. The age at which a first pregnancy occurs is increasing from the thirties to the forties. This increase and the recurrence rate of leiomyomas from 15 to 30% points to the effect of myomas on the infertility. Mechanisms by which myomas may cause infertility are abnormal uterine contractility, elongation of the uterine cavity, and distortion of uterine vascularization. Surgery may have beneficial or adverse effects without clear data on its effect on the assisted reproductive technology (ART) procedures. The present study was undertaken to establish the impact of surgical removal of myomas on fertility and infertility of patients undergoing ART procedures. Patients who underwent surgical removal of myomas before in vitro fertilization (Group A) had a cumulative success rate of 33% for one to three procedures (28 clinical pregnancies in 84 patients) and delivery rate of 25% (21 live births in 84 patients). Patients who underwent in vitro fertilization without previous surgery (Group B) had a 15% clinical pregnancy rate (13 pregnancies in 84 patients) (P < 0.05) and 12% delivery rate (10 deliveries in 84 pregnancies) (P < 0.05). Abortion rates were 7% (8 deliveries in 84 patients) and 4% (3 deliveries in 84 patients) in Groups A and B, respectively. This study confirms the beneficial effect of surgical removal of fibroids before undergoing ART procedures.