Department of Obstetrics and Gynecology, Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt.
Fertil Steril. 2010 Jul;94(2):724-9. doi: 10.1016/j.fertnstert.2009.03.075. Epub 2009 May 5.
To determine whether hysteroscopic myomectomy for submucous fibroids in women with unexplained primary infertility achieved better pregnancy rates than no intervention.
Prospective randomized matched control trial.
Tertiary university fertility care unit.
PATIENT(S): From January 1999 to February 2006, a total of 215 women with unexplained primary infertility and with ultrasonographically diagnosed submucous myomas as the sole cause for fertility failure were recruited.
INTERVENTION(S): Women were randomly allocated to one of two pretreatment groups matched by age. Hysteroscopic myomectomy was performed in the study group (n = 101). Diagnostic hysteroscopy and myoma biopsy was performed in the control group (n = 103). No fertility therapy was given for either group.
MAIN OUTCOME MEASURE(S): Clinical pregnancy rates according to patient and myoma characteristics.
RESULT(S): The baseline characteristics of both patients and submucous myomas were comparable. Among patients with complete follow-up, a total of 93 (45.6%) pregnancies occured-64 (63.4%) in the study group and 29 (28.2%) in the control group. Women in the study group had a better possibility of becoming pregnant after hysteroscopic myomectomy with a relative risk of 2.1 (95% confidence interval, 1.5-2.9). No difference in pregnancy rates was observed according to size, number, and location of myomas in both groups. However, fertility rates appeared to increase after hysteroscopic myomectomy of type 0 and type I myomas (P < 0.05). In contrast, for the subgroup of patients with type II myomas, no difference in fertility rates were noted.
CONCLUSION(S): Hysteroscopic myomectomy for submucous fibroids in women with unexplained primary infertility is effective in achieving a better pregnancy rate. We think that a multicenter study should be conducted before evaluating the impact of submucous myoma characteristics on fertility outcome.
确定宫腔镜下黏膜下肌瘤切除术对不明原因原发性不孕患者的妊娠率是否优于不干预。
前瞻性随机配对对照试验。
三级大学生育保健单位。
1999 年 1 月至 2006 年 2 月，共招募了 215 名不明原因原发性不孕且超声诊断为黏膜下肌瘤是导致生育失败的唯一原因的妇女。
将妇女随机分配到两组预处理组中，两组按年龄匹配。研究组（n=101）行宫腔镜下肌瘤切除术。对照组（n=103）行诊断性宫腔镜检查和肌瘤活检。两组均未给予任何生育治疗。
根据患者和肌瘤特征的临床妊娠率。
两组患者和黏膜下肌瘤的基线特征均相似。在完成随访的患者中，共有 93 例（45.6%）妊娠-研究组 64 例（63.4%），对照组 29 例（28.2%）。宫腔镜下肌瘤切除术后，患者妊娠的可能性更大，相对风险为 2.1（95%置信区间，1.5-2.9）。两组肌瘤大小、数量和位置对妊娠率无差异。然而，宫腔镜下肌瘤切除术对 0 型和 1 型肌瘤的生育能力似乎有提高作用（P<0.05）。相比之下，对于 2 型肌瘤患者亚组，生育能力无差异。
宫腔镜下黏膜下肌瘤切除术对不明原因原发性不孕患者有效，可提高妊娠率。我们认为，在评估黏膜下肌瘤特征对生育结局的影响之前，应该进行多中心研究。
