Klip H, van Leeuwen F E, Schats R, Burger C W
Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Hum Reprod. 2003 Sep;18(9):1951-8. doi: 10.1093/humrep/deg358.
Over the past decade, attention has been focused increasingly on the long-term health effects of IVF in women. Assuming that hormonal changes due to stimulation regimens for IVF are strongest among 'high' responders, we evaluated whether responsiveness to ovarian stimulation in IVF is predictive of the risk of benign gynaecological disorders >12 months after the last IVF cycle.
A nationwide historical cohort study of women who underwent IVF treatment was conducted. After a median time of 4.6 years following the last IVF treatment cycle, 8714 cohort members completed a health survey questionnaire that inquired about reproductive variables and the occurrence and age at onset of specific medical conditions including uterine leiomyoma, surgically removed ovarian cysts and thyroid disorders. Detailed data on cause of subfertility and IVF treatment were collected from the medical records. Women were included in the 'high responders' group when on average >/=14 oocytes were retrieved per IVF cycle (n = 1562), in the 'normal responders' group when they had a mean number of 4-13 retrieved oocytes (n = 6033), and in the 'low responders' group when they had a mean number of 0-3 retrieved oocytes per cycle (n = 1119).
Among women with a high response to ovarian stimulation, we found a borderline significantly decreased risk of uterine leiomyoma [relative risk (RR) = 0.6; 95% confidence interval (CI) 0.4-1.0] and surgically removed ovarian cysts (RR = 0.6; 95% CI 0.3-1.0) in comparison with 'normal responders'. After OHSS, the age-adjusted RRs were 1.8 (95% CI 0.9-3.8) for having surgically removed ovarian cysts and 1.0 (95% CI 0.4-2.2) for uterine leiomyoma (both not significant).
Despite the small number of events observed, highly elevated risks of gynaecological disorders and hormonal diseases in women undergoing IVF treatment can be excluded based on the present data and this follow-up period. Women with a low response to ovarian stimulation tended to have higher risks of benign gynaecological diseases than high responders.
在过去十年中，人们越来越关注体外受精（IVF）对女性长期健康的影响。假设由于IVF刺激方案导致的激素变化在“高反应者”中最为强烈，我们评估了IVF中卵巢刺激反应性是否能预测最后一个IVF周期后超过12个月出现良性妇科疾病的风险。
对接受IVF治疗的女性进行了一项全国性历史队列研究。在最后一个IVF治疗周期后的中位时间4.6年，8714名队列成员完成了一份健康调查问卷，询问了生殖变量以及包括子宫肌瘤、手术切除的卵巢囊肿和甲状腺疾病在内的特定疾病的发生情况和发病年龄。从医疗记录中收集了关于不孕原因和IVF治疗的详细数据。每个IVF周期平均回收≥14个卵母细胞的女性被纳入“高反应者”组（n = 1562），回收卵母细胞平均数为4 - 13个的女性被纳入“正常反应者”组（n = 6033），每个周期平均回收卵母细胞数为0 - 3个的女性被纳入“低反应者”组（n = 1119）。
与“正常反应者”相比，在对卵巢刺激反应高的女性中，我们发现子宫肌瘤风险有临界显著降低[相对风险（RR）= 0.6；95%置信区间（CI）0.4 - 1.0]以及手术切除卵巢囊肿风险降低（RR = 0.6；95% CI 0.3 - 1.0）。卵巢过度刺激综合征（OHSS）后，手术切除卵巢囊肿的年龄调整后RR为1.8（95% CI 0.9 - 3.8），子宫肌瘤为1.0（95% CI 0.4 - 2.2）（两者均无显著性）。
尽管观察到的事件数量较少，但根据目前的数据和随访期，可以排除接受IVF治疗的女性患妇科疾病和激素疾病的高风险。卵巢刺激反应低的女性患良性妇科疾病的风险往往高于高反应者。
