Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.
Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.
Fertil Steril. 2017 Sep;108(3):483-490.e3. doi: 10.1016/j.fertnstert.2017.06.025.
To systematically review and summarize the existing evidence related to the effect of adenomyosis on fertility and on in vitro fertilization (IVF) clinical outcomes, and to explore the effects of surgical or medical treatments.
Meta-analysis.
Not applicable.
PATIENT(S): An electronic-based search was performed with the use of the following databases: Pubmed, Embase, Ovid Medline, Cochrane Central Register of Controlled Trials, and Google Scholar, identifying all related articles up to November 2016. We included 11 comparative studies that evaluated the clinical outcomes of IVF treatments in women with (519 patients) and without (1,535 patients) adenomyosis diagnosed with the use of magnetic resonance imaging or transvaginal ultrasound. We also separately evaluated four articles comparing fertility outcomes in two groups of infertile adenomyotic patients untreated and treated surgically or medically with the use of GnRH agonist (GnRHa).
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Primary outcome: clinical pregnancy rate after IVF.
rates of implantation, ongoing pregnancy, live birth, miscarriage, and ectopic pregnancy. The summary measures were expressed as odds ratio (OR) and 95% confidence interval (CI).
RESULT(S): The rates of implantation, clinical pregnancy per cycle, clinical pregnancy per embryo transfer, ongoing pregnancy, and live birth among women with adenomyosis were significantly lower than in those without adenomyosis. The miscarriage rate in women with adenomyosis was higher than in those without adenomyosis. It appears that surgical treatment or treatment withf GnRHa increases the spontaneous pregnancy rate in women with adenomyosis.
CONCLUSION(S): Adenomyosis has a detrimental effect on IVF clinical outcomes. Pretreatment with the use of long-term GnRHa or long protocol could be beneficial.
系统回顾和总结腺肌病对生育能力和体外受精（IVF）临床结局的影响的现有证据，并探讨手术或药物治疗的效果。
荟萃分析。
不适用。
使用以下数据库进行电子检索：Pubmed、Embase、Ovid Medline、Cochrane 对照试验中心注册库和 Google Scholar，检索截至 2016 年 11 月的所有相关文章。我们纳入了 11 项比较研究，评估了经磁共振成像或经阴道超声诊断为腺肌病的妇女（519 例）和无腺肌病的妇女（1535 例）接受 IVF 治疗的临床结局。我们还分别评估了 4 项比较两组未接受治疗和接受 GnRH 激动剂（GnRHa）手术或药物治疗的不孕腺肌病患者的生育结局的文章。
无。
IVF 后的临床妊娠率。
种植率、持续妊娠率、活产率、流产率和异位妊娠率。汇总指标以比值比（OR）和 95%置信区间（CI）表示。
腺肌病患者的种植率、每周期临床妊娠率、每胚胎移植临床妊娠率、持续妊娠率和活产率明显低于无腺肌病患者。腺肌病患者的流产率高于无腺肌病患者。似乎手术治疗或使用 GnRHa 治疗可提高腺肌病患者的自然妊娠率。
腺肌病对 IVF 临床结局有不良影响。使用长期 GnRHa 或长方案预处理可能有益。
