Dueholm Margit
Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark.
Acta Obstet Gynecol Scand. 2017 Jun;96(6):715-726. doi: 10.1111/aogs.13158.
This review includes an analysis of the clinical studies evaluating reproductive outcome and adenomyosis, and a review of studies on reproductive outcome and surgical treatment options for adenomyosis. Strict diagnostic criteria and classification of disease are needed for an image diagnosis of adenomyosis. Studies of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) populations and women with surgically treated deep endometriosis have suggested that adenomyosis has a negative impact on reproductive outcome, although there are substantial variations between studies. Few data are available on the relation between the extent of disease and impact on reproductive outcome, but a correlation appears to exist. Case series seem to confirm a positive effect of gonadotropin-releasing hormone analog treatment and surgery on reproductive outcome, but there are no controlled trials. Evidence is impaired by the poor quality of many studies, a lack of strict image diagnosis, and the absence of a classification of the extent of disease. Selection of the optimal evidence-based treatment options for adenomyosis in the fertility clinic is difficult because of a lack of evidence regarding the relation between fertility and the degree and composition of adenomyosis. Adenomyosis may reduce implantation so severely that surgical or other treatment options should be recommended, but the benefit of these treatment options needs to be verified. Referral of women with adenomyosis and recurrent miscarriage and repeated failure of assisted reproductive technology to centers with a special interest in adenomyosis research and treatment may be critical.
本综述包括对评估子宫腺肌病生殖结局的临床研究的分析，以及对子宫腺肌病生殖结局和手术治疗选择的研究综述。子宫腺肌病的影像学诊断需要严格的诊断标准和疾病分类。对体外受精/卵胞浆内单精子注射（IVF/ICSI）人群以及接受手术治疗的深部子宫内膜异位症女性的研究表明，子宫腺肌病对生殖结局有负面影响，尽管不同研究之间存在很大差异。关于疾病程度与对生殖结局影响之间的关系，可用数据很少，但似乎存在相关性。病例系列似乎证实了促性腺激素释放激素类似物治疗和手术对生殖结局有积极作用，但尚无对照试验。许多研究质量较差、缺乏严格的影像学诊断以及疾病程度分类缺失，影响了证据的可靠性。由于缺乏关于生育能力与子宫腺肌病程度及组成之间关系的证据，在生育门诊选择基于证据的子宫腺肌病最佳治疗方案很困难。子宫腺肌病可能严重降低着床率，因此应推荐手术或其他治疗方案，但这些治疗方案的益处需要得到验证。将患有子宫腺肌病、复发性流产和辅助生殖技术反复失败的女性转诊至对子宫腺肌病研究和治疗有特殊兴趣的中心可能至关重要。
