Surrey Eric S
Colorado Center for Reproductive Medicine, Englewood, Colorado 80110, USA.
Curr Opin Obstet Gynecol. 2003 Jun;15(3):239-42. doi: 10.1097/00001703-200306000-00005.
The effect of leiomyomata on implantation and pregnancy rates resulting from in-vitro fertilization-embryo transfer has not been clearly defined. Submucosal and intramural leiomyomata which distort the endometrial cavity clearly affect outcome. However, the impact and possible mechanism of action of intramural lesions, which do not clearly alter the contour of the endometrial cavity, remain controversial. This review evaluates recent literature addressing these issues.
Several recent studies have evaluated the impact of leiomyomata on the uterine environment. Alterations in uterine artery blood flow may have an impact on implantation, although conflicting results have been reported. Other recent studies have evaluated alterations in gene expression and local cytokine release which may also play a role. Five recently published clinical case-controlled trials provide conflicting information regarding the impact of these lesions on in-vitro fertilization-embryo transfer cycle outcome as measured by clinical pregnancy and implantation rates. Results varied from no effect to a highly significant and deleterious impact on cycle outcomes. These differences may be partly attributable to differences in patient inclusion criteria and inconsistencies in analyses of precise fibroid location and size.
Intramural leiomyomata, which impinge upon the uterine cavity, negatively affect in-vitro fertilization-embryo transfer cycle outcome. Myomectomy should be beneficial in these circumstances despite an absence of data in this regard. No definitive statements can be made regarding intramural leiomyomata, which do not distort the cavity due to differing outcomes from currently available investigations. In the absence of more clear cut data, no recommendation can be made to support routine myomectomy in these cases. Rather, clinical management should be individualized.
子宫肌瘤对体外受精 - 胚胎移植的着床率和妊娠率的影响尚未明确界定。明显扭曲子宫内膜腔的黏膜下肌瘤和壁间肌瘤显然会影响结局。然而，那些并未明显改变子宫内膜腔轮廓的壁间肌瘤的影响及可能的作用机制仍存在争议。本综述评估了针对这些问题的近期文献。
最近的几项研究评估了子宫肌瘤对子宫环境的影响。子宫动脉血流的改变可能会影响着床，尽管报道的结果相互矛盾。其他近期研究评估了基因表达和局部细胞因子释放的改变，这些改变也可能起作用。最近发表的五项临床病例对照试验，就这些肌瘤对体外受精 - 胚胎移植周期结局（以临床妊娠率和着床率衡量）的影响提供了相互矛盾的信息。结果从无影响到对周期结局有高度显著的有害影响不等。这些差异可能部分归因于患者纳入标准的不同以及对肌瘤精确位置和大小分析的不一致。
侵犯子宫腔的壁间肌瘤会对体外受精 - 胚胎移植周期结局产生负面影响。尽管缺乏这方面的数据，但在这些情况下肌瘤切除术应该是有益的。对于那些未扭曲宫腔的壁间肌瘤，由于目前现有研究结果各异，无法做出明确的结论。在没有更明确的数据的情况下，无法建议支持在这些病例中进行常规肌瘤切除术。相反，临床管理应个体化。
