Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University; National Research Center for Assisted Reproductive Technology and Reproductive Genetics; Key Laboratory for Reproductive Endocrinology of Ministry of Education; and Shandong Provincial Key Laboratory of Reproductive Medicine, Jinan, People's Republic of China.
Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University; National Research Center for Assisted Reproductive Technology and Reproductive Genetics; Key Laboratory for Reproductive Endocrinology of Ministry of Education; and Shandong Provincial Key Laboratory of Reproductive Medicine, Jinan, People's Republic of China.
Fertil Steril. 2018 May;109(5):817-822.e2. doi: 10.1016/j.fertnstert.2018.01.007. Epub 2018 Mar 28.
To evaluate the influence of type 3 intramural fibroids on in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) outcomes.
Retrospective cohort study.
University-based reproductive medicine center.
PATIENT(S): All women undergoing IVF-ICSI from January 1, 2009, to December 31, 2016, in our unit.
INTERVENTION(S): Each woman was matched with three separate control subjects of the same age (±1 year), number of cycles, type of infertility (primary or secondary), type of protocol used for controlled ovarian hyperstimulation (COH), and no uterine fibroids identified by transvaginal ultrasound.
MAIN OUTCOME MEASURE(S): Implantation, clinical pregnancy, clinical miscarriage, and live birth rates.
RESULT(S): We included 151 patients with type 3 intramural fibroids and 453 matched control subjects who underwent IVF-ICSI. The rate of "other protocol" used in COH was significantly higher in women with type 3 fibroids than in the control subjects (P<.001). The experimental group had a significantly lower implantation rate. Type 3 fibroids also resulted in a lower frequency of live births and clinical pregnancy. There was no significant difference between the groups in the rate of clinical miscarriage. Compared with the corresponding control subjects, patients with type 3 fibroids with a single fibroid diameter (SD) or total reported fibroid diameter (TD) >2.0 cm also had significantly lower rates of live birth, clinical pregnancy, and implantation. Type 3 fibroids with SD or TD ≤2.0 cm had no significant difference in IVF-ICSI outcomes compared with corresponding control subjects.
CONCLUSION(S): Our results suggest that type 3 fibroids exert a negative impact on the rates of implantation, clinical pregnancy, and live birth in patients undergoing IVF-ICSI, but do not significantly increase the clinical miscarriage rate. The deleterious impact of type 3 fibroids was remarkable in women with type 3 fibroids with TD or SD >2.0 cm.
评估 3 型子宫壁内肌瘤对体外受精-胞浆内单精子注射（IVF-ICSI）结局的影响。
回顾性队列研究。
以大学为基础的生殖医学中心。
2009 年 1 月 1 日至 2016 年 12 月 31 日期间在我院行 IVF-ICSI 的所有女性。
每位女性均与同年龄（±1 岁）、周期数、不孕类型（原发或继发）、用于控制性卵巢过度刺激（COH）的方案类型和经阴道超声未发现子宫肌瘤的 3 名单独对照者相匹配。
种植率、临床妊娠率、临床流产率和活产率。
共纳入 151 例 3 型子宫壁内肌瘤患者和 453 例匹配对照者，行 IVF-ICSI。COH 中“其他方案”的使用率在 3 型肌瘤患者中显著高于对照组（P<.001）。实验组的种植率显著降低。3 型肌瘤还导致活产率和临床妊娠率降低。两组间临床流产率无显著差异。与相应对照组相比，单发肌瘤直径（SD）或总报告肌瘤直径（TD）>2.0 cm 的 3 型肌瘤患者的活产率、临床妊娠率和种植率显著降低。SD 或 TD≤2.0 cm 的 3 型肌瘤患者与相应对照组相比，IVF-ICSI 结局无显著差异。
我们的结果表明，3 型肌瘤对行 IVF-ICSI 的患者的种植率、临床妊娠率和活产率有负面影响，但并不显著增加临床流产率。TD 或 SD>2.0 cm 的 3 型肌瘤患者的肌瘤负面影响显著。
