Rocha Tainá Pezzin, Andres Marina Paula, Borrelli Giuliano Moysés, Abrão Mauricio Simões
1 Endometriosis Section, Gynecologic Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil.
2 Gynecologic Division, BP-A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil.
Reprod Sci. 2018 Apr;25(4):480-486. doi: 10.1177/1933719118756754. Epub 2018 Feb 5.
Adenomyosis is a benign gynecological disease observed in women in their reproductive age. Recent studies have shown that adenomyosis might be a relevant factor for infertility, either impairing implantation or leading to early miscarriage. However, conservative treatment of infertility related to adenomyosis is still unclear. This study systematically reviews the literature for the reproductive outcomes of the available conservative treatments for patients with adenomyosis-associated infertility. We conducted a search in PubMed/Medline for studies in English published in the last 7 years and included 16 studies. Six studies evaluated surgical treatments of adenomyosis. When considering only spontaneous pregnancies, the overall clinical pregnancy rate was very low (18.2%). However, when using GnRH analogues for 24 weeks after surgery, the pooled spontaneous pregnancy rate was higher (40.7% vs 15.0%; P = .002). No significant difference was observed in the other outcomes. Ten studies evaluated exclusive assisted reproductive techniques for infertility related to adenomyosis and showed that the long stimulation protocol had better outcomes compared to short stimulation protocol in pregnancy rate (43.3% vs 31.8%; P = .0001), live birth (43.0% vs 23.1%; P = .005), and miscarriage (18.5% vs 31.1%; P < .0001).
子宫腺肌病是一种在育龄期女性中观察到的良性妇科疾病。最近的研究表明，子宫腺肌病可能是导致不孕的一个相关因素，要么损害着床，要么导致早期流产。然而，与子宫腺肌病相关的不孕症的保守治疗仍不明确。本研究系统回顾了有关子宫腺肌病相关性不孕症患者现有保守治疗的生殖结局的文献。我们在PubMed/Medline中检索了过去7年发表的英文研究，纳入了16项研究。6项研究评估了子宫腺肌病的手术治疗。仅考虑自然妊娠时，总体临床妊娠率非常低（18.2%）。然而，术后使用促性腺激素释放激素（GnRH）类似物24周时，汇总的自然妊娠率更高（40.7%对15.0%；P = 0.002）。在其他结局方面未观察到显著差异。10项研究评估了针对子宫腺肌病相关性不孕症的单纯辅助生殖技术，结果显示，在妊娠率（43.3%对31.8%；P = 0.0001）、活产率（43.0%对23.1%；P = 0.005）和流产率（18.5%对31.1%；P < 0.0001）方面，长方案刺激比短方案刺激有更好的结局。
