Healy D L
Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia.
Environ Health Perspect. 2000 Oct;108 Suppl 5:845-7. doi: 10.1289/ehp.00108s5845.
Our objective was to investigate the effect of subserosal (SS), intramural (IM), and submucosal (SM) fibroids on the outcome of assisted reproductive technology (ART) treatment. A retrospective comparative study at a tertiary referral center for infertility was designed. The treatment outcome of 106 ART cycles in 88 patients with uterine fibroids (33 SS, 46 IM without cavity distortion, 9 SM) was compared with that of 318 ART cycles in age-matched patients without fibroids. The main outcome measure(s) were the findings on transvaginal uterine ultrasonography performed before the initiation of treatment and pregnancy and implantation rates. The pregnancy rates per transfer were 34.1, 16.4, 10, and 30.1% in the patients with SS fibroids, IM fibroids, SM fibroids, and no fibroids, respectively. The implantation rates were 15.1, 6.4, 4.3, and 15.7%, respectively. Both rates were significantly lower in patients with IM fibroids than in those with SS fibroids or no fibroids. We conclude that pregnancy and implantation rates were significantly lower in the groups of patients with IM and SM fibroids, even when there was no deformation of the uterine cavity. Pregnancy and implantation rates were not influenced by the presence of SS fibroids. Surgical or medical treatment should be considered in infertile patients who have IM and/or SM fibroids before resorting to ART treatment.
我们的目的是研究浆膜下（SS）、肌壁间（IM）和黏膜下（SM）子宫肌瘤对辅助生殖技术（ART）治疗结局的影响。我们在一家三级不孕不育转诊中心开展了一项回顾性对照研究。将88例子宫肌瘤患者（33例浆膜下肌瘤、46例肌壁间肌瘤且宫腔无变形、9例黏膜下肌瘤）的106个ART周期的治疗结局，与年龄匹配的无肌瘤患者的318个ART周期的治疗结局进行比较。主要观察指标为治疗开始前经阴道子宫超声检查结果、妊娠率和着床率。浆膜下肌瘤患者、肌壁间肌瘤患者、黏膜下肌瘤患者和无肌瘤患者每次移植的妊娠率分别为34.１%、16.4%、10%和30.1%。着床率分别为15.1%、6.4%、4.3%和15.7%。肌壁间肌瘤患者的这两项比率均显著低于浆膜下肌瘤患者或无肌瘤患者。我们得出结论，即使宫腔无变形，肌壁间肌瘤和黏膜下肌瘤患者组的妊娠率和着床率也显著较低。浆膜下肌瘤的存在不影响妊娠率和着床率。对于有肌壁间和/或黏膜下肌瘤的不孕患者，在采用ART治疗前应考虑手术或药物治疗。
