Khalaf Y, Ross C, El-Toukhy T, Hart R, Seed P, Braude P
Assisted Conception Unit, Guy's and St. Thomas' Hospital NHS Foundation Trust, Department of Women's Health, King's College London, UK.
Hum Reprod. 2006 Oct;21(10):2640-4. doi: 10.1093/humrep/del218. Epub 2006 Jun 21.
This study aimed to evaluate the effect of small intramural fibroids on the cumulative pregnancy, ongoing pregnancy, live birth and implantation rates after three IVF/ICSI attempts.
The first three treatment cycles of women enrolled for IVF/ICSI over a 12-month period were analysed. Only patients with small (<or=5 cm) intramural fibroids not encroaching upon the endometrial cavity were included in the fibroid group. Cox's hazards regression was used to estimate the hazard ratio (HR) associated with the presence of intramural fibroids.
During the study period, 322 women without fibroids (control group) and 112 women with fibroids (study group) underwent 606 IVF/ICSI cycles. The pregnancy, ongoing pregnancy and live birth rates in the study group were 23.6, 18.8 and 14.8% compared with 32.9, 28.5 and 24% in the control group, respectively (P<0.05). Cox regression analysis showed that the pregnancy rate at each cycle was reduced by 39% (HR=0.61, 95% CI=0.39-0.95, P=0.029) in the study group compared with the control group. The cumulative ongoing pregnancy rate was reduced by 43% (HR=0.57, 95% CI=0.35-0.91, P=0.018), and the cumulative live birth rate was reduced by 47% (HR=0.53, 95% CI=0.32-0.87, P=0.013) in the study group. After adjusting for confounding variables, the presence of fibroids was found to significantly reduce the ongoing pregnancy rate at each cycle of IVF/ICSI by 40% (HR=0.60, 95% CI=0.36-0.99, P=0.048) and the live birth rate at each cycle by 45% (HR=0.55, 95% CI=0.32-0.95, P=0.03).
Small intramural fibroids are associated with a significant reduction in the cumulative pregnancy, ongoing pregnancy and live birth rates after three IVF/ICSI cycles.
本研究旨在评估小的肌壁间肌瘤对三次体外受精/卵胞浆内单精子注射（IVF/ICSI）尝试后的累积妊娠率、持续妊娠率、活产率和着床率的影响。
对在12个月期间登记接受IVF/ICSI治疗的女性的前三个治疗周期进行分析。肌瘤组仅纳入肌壁间肌瘤小（≤5 cm）且未侵犯子宫内膜腔的患者。采用Cox风险回归分析来估计与肌壁间肌瘤存在相关的风险比（HR）。
在研究期间，322名无肌瘤女性（对照组）和112名有肌瘤女性（研究组）接受了606个IVF/ICSI周期治疗。研究组的妊娠率、持续妊娠率和活产率分别为23.6%、18.8%和14.8%，而对照组分别为32.9%、28.5%和24%（P<0.05）。Cox回归分析显示，与对照组相比，研究组每个周期的妊娠率降低了39%（HR=0.61，95%可信区间[CI]=0.39-0.95，P=0.029）。研究组的累积持续妊娠率降低了43%（HR=0.57，95% CI=0.35-0.91，P=0.018），累积活产率降低了47%（HR=0.53，95% CI=0.32-0.87，P=0.013）。在对混杂变量进行校正后，发现肌瘤的存在显著降低了IVF/ICSI每个周期的持续妊娠率40%（HR=0.60，95% CI=0.36-0.99，P=0.048）和每个周期的活产率45%（HR=0.55，95% CI=0.32-0.95，P=0.03）。
小的肌壁间肌瘤与三次IVF/ICSI周期后的累积妊娠率、持续妊娠率和活产率显著降低相关。
