不明原因不孕症患者经卵巢刺激-宫腔内人工授精后子宫肌瘤与妊娠结局的关联
Association of uterine fibroids and pregnancy outcomes after ovarian stimulation-intrauterine insemination for unexplained infertility.
作者信息
Styer Aaron K, Jin Susan, Liu Dan, Wang Baisong, Polotsky Alex J, Christianson Mindy S, Vitek Wendy, Engmann Lawrence, Hansen Karl, Wild Robert, Legro Richard S, Coutifaris Christos, Alvero Ruben, Robinson Randal D, Casson Peter, Christman Gregory M, Christy Alicia, Diamond Michael P, Eisenberg Esther, Zhang Heping, Santoro Nanette
机构信息
Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.
Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut.
出版信息
Fertil Steril. 2017 Mar;107(3):756-762.e3. doi: 10.1016/j.fertnstert.2016.12.012. Epub 2017 Jan 12.
OBJECTIVE
To investigate the association of non-cavity-distorting uterine fibroids and pregnancy outcomes after ovarian stimulation-intrauterine insemination (OS-IUI) in couples with unexplained infertility.
DESIGN
Secondary analysis from a prospective, randomized, multicenter clinical trial investigating fertility outcomes after OS-IUI.
SETTING
Reproductive Medicine Network clinical sites.
PATIENT(S): Nine hundred couples with unexplained infertility who participated in the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) clinical trial.
INTERVENTION(S): Participants were randomized to one of three arms (clomiphene citrate, letrozole, or gonadotropins), and treatment was continued for up to four cycles or until pregnancy was achieved.
MAIN OUTCOMES MEASURE(S): Conception (serum hCG increase), clinical pregnancy (fetal cardiac activity), and live birth rates.
RESULT(S): A total of 102/900 participants (11.3%) had at least one documented fibroid and a normal uterine cavity. Women with fibroids were older, more likely to be African American, had a greater uterine volume, lower serum antimüllerian hormone levels, and fewer antral follicles than women without fibroids. In conception cycles, clinical pregnancy rates were significantly lower in participants with fibroids than in those without uterine fibroids. Pregnancy loss before 12 weeks was more likely in African American women with fibroids compared with non-African American women with fibroids. There was no difference in conception and live birth rates in subjects with and without fibroids.
CONCLUSION(S): No differences were observed in conception and live birth rates in women with non-cavity-distorting fibroids and those without fibroids. These findings provide reassurance that pregnancy success is not impacted in couples with non-cavity-distorting fibroids undergoing OS-IUI for unexplained infertility.
CLINICAL TRIAL REGISTRATION NUMBER
NCT01044862.
目的
探讨不明原因不孕夫妇在卵巢刺激-宫腔内人工授精（OS-IUI）后，非使宫腔变形的子宫肌瘤与妊娠结局之间的关联。
设计
对一项前瞻性、随机、多中心临床试验进行二次分析，该试验旨在研究OS-IUI后的生育结局。
地点
生殖医学网络临床站点。
患者
900对不明原因不孕的夫妇，他们参与了卵巢刺激多胎宫内妊娠评估（AMIGOS）临床试验。
干预措施
参与者被随机分为三组之一（枸橼酸氯米芬、来曲唑或促性腺激素），治疗持续最多四个周期或直至妊娠。
主要观察指标
受孕（血清人绒毛膜促性腺激素升高）、临床妊娠（胎儿心搏）和活产率。
结果
共有102/900名参与者（11.3%）至少有一个记录在案的肌瘤且宫腔正常。有肌瘤的女性比没有肌瘤的女性年龄更大，更有可能是非裔美国人，子宫体积更大，血清抗苗勒管激素水平更低，窦卵泡更少。在受孕周期中，有肌瘤的参与者的临床妊娠率显著低于没有子宫肌瘤的参与者。与没有肌瘤的非裔美国女性相比，有肌瘤的非裔美国女性在12周前发生流产的可能性更大。有肌瘤和没有肌瘤的受试者在受孕率和活产率方面没有差异。
结论
在有非使宫腔变形肌瘤的女性和没有肌瘤的女性中，未观察到受孕率和活产率有差异。这些发现为接受OS-IUI治疗不明原因不孕的有非使宫腔变形肌瘤的夫妇提供了安心的保证，即妊娠成功率不会受到影响。
临床试验注册号
NCT01044862。
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