Pritts Elizabeth A, Parker William H, Olive David L
Wisconsin Fertility Institute, Middleton, Wisconsin 53562, USA.
Fertil Steril. 2009 Apr;91(4):1215-23. doi: 10.1016/j.fertnstert.2008.01.051. Epub 2008 Mar 12.
To investigate the effect of fibroids on fertility and of myomectomy in improving outcomes.
Systematic literature review and meta-analysis of existing controlled studies.
Private center for Reproductive endocrinology and infertility.
PATIENT(S): Women with fibroids and infertility.
INTERVENTION(S): A systematic literature review, raw data extraction and data analysis.
MAIN OUTCOME MEASURE(S): Clinical pregnancy rate, spontaneous abortion rate, ongoing pregnancy/live birth rate, implantation rate, and preterm delivery rate in women with and without fibroids, and in women who underwent myomectomy.
RESULT(S): Women with subserosal fibroids had no differences in their fertility outcomes compared with infertile controls with no myomas, and myomectomy did not change these outcomes compared with women with fibroids in situ. Women with intramural fibroids appear to have decreased fertility and increased pregnancy loss compared with women without such tumors, but study quality is poor. Myomectomy does not significantly increase the clinical pregnancy and live birth rates, but the data are scarce. Fibroids with a submucosal component led to decreased clinical pregnancy and implantation rates compared with infertile control subjects. Removal of submucous myomas appears likely to improve fertility.
CONCLUSION(S): Fertility outcomes are decreased in women with submucosal fibroids, and removal seems to confer benefit. Subserosal fibroids do not affect fertility outcomes, and removal does not confer benefit. Intramural fibroids appear to decrease fertility, but the results of therapy are unclear. More high-quality studies need to be directed toward the value of myomectomy for intramural fibroids, focusing on issues such as size, number, and proximity to the endometrium.
探讨子宫肌瘤对生育的影响以及子宫肌瘤切除术对改善生育结局的作用。
对现有对照研究进行系统文献综述和荟萃分析。
私立生殖内分泌与不孕症中心。
患有子宫肌瘤且不孕的女性。
系统文献综述、原始数据提取和数据分析。
有或无子宫肌瘤的女性以及接受子宫肌瘤切除术的女性的临床妊娠率、自然流产率、持续妊娠/活产率、着床率和早产率。
与无肌瘤的不孕对照组相比，浆膜下子宫肌瘤患者的生育结局无差异，与原位子宫肌瘤患者相比，子宫肌瘤切除术并未改变这些结局。与无此类肿瘤的女性相比，肌壁间子宫肌瘤患者的生育能力似乎降低且妊娠丢失增加，但研究质量较差。子宫肌瘤切除术并未显著提高临床妊娠率和活产率，但数据较少。与不孕对照组相比，有黏膜下成分的子宫肌瘤导致临床妊娠率和着床率降低。切除黏膜下肌瘤似乎有可能提高生育能力。
黏膜下子宫肌瘤患者的生育结局降低，切除似乎有益。浆膜下子宫肌瘤不影响生育结局，切除无益处。肌壁间子宫肌瘤似乎会降低生育能力，但治疗结果尚不清楚。需要更多高质量研究来关注子宫肌瘤切除术对肌壁间子宫肌瘤的价值，重点关注肌瘤大小、数量和与子宫内膜的距离等问题。
