Takahashi Nozomi, Harada Miyuki, Tanabe Ryosuke, Takayanagi Akane, Izumi Gentaro, Oi Nagisa, Hirata Tetsuya, Wada-Hiraike Osamu, Fujii Tomoyuki, Osuga Yutaka
Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
J Obstet Gynaecol Res. 2018 Oct;44(10):1956-1962. doi: 10.1111/jog.13754. Epub 2018 Jul 13.
The objective of this study is to determine the factors associated with successful pregnancy in women of late reproductive age with uterine fibroids who undergo embryo cryopreservation before surgery (ECBS).
Patients who underwent in vitro fertilization treatment with controlled ovarian stimulation from November 2010 to January 2017 in our university hospital were included. Twenty-two patients older than 35 years of age at the first visit with cavity-distorting uterine fibroids underwent ECBS, a three-step therapeutic approach consisting of oocyte pick-up, myomectomy and embryo transfer (ET), which are performed in this order. We retrospectively calculated the pregnancy rate and determined the factors associated with successful pregnancy.
The mean age at ET of the patients who underwent ECBS was 40.9 years, with a pregnancy rate per ET of 36.8% (21/57). Of 22 patients, 10 (45.5%) successfully continued pregnancy beyond 12 weeks of gestation (ongoing pregnancy). An ongoing pregnancy was observed only among the patients with more than three frozen embryos. The ongoing pregnancy rates of patients with ≤five fibroids and ≤5 cm in the maximal diameter were significantly higher compared to the respective remaining group (90.0% vs 14.3% and 87.5% vs 33.3%).
ECBS is an effective strategy for infertile women of late reproductive age with cavity-distorting uterine fibroids, especially when it is applied to the patients who can freeze at least three embryos before myomectomy, with five or less fibroids smaller than 5 cm in the maximal diameter.
本研究的目的是确定在手术前接受胚胎冷冻保存（ECBS）的患有子宫肌瘤的晚育年龄女性成功妊娠的相关因素。
纳入2010年11月至2017年1月在我校医院接受控制性卵巢刺激的体外受精治疗的患者。22例初次就诊时年龄超过35岁且患有使宫腔变形的子宫肌瘤的患者接受了ECBS，这是一种三步治疗方法，依次包括取卵、肌瘤切除术和胚胎移植（ET）。我们回顾性计算了妊娠率并确定了与成功妊娠相关的因素。
接受ECBS的患者进行ET时的平均年龄为40.9岁，每次ET的妊娠率为36.8%（21/57）。22例患者中，10例（45.5%）成功维持妊娠至妊娠12周以上（持续妊娠）。仅在冷冻胚胎超过3个的患者中观察到持续妊娠。肌瘤≤5个且最大直径≤5 cm的患者的持续妊娠率明显高于各自的其余组（90.0%对14.3%以及87.5%对33.3%）。
ECBS是患有使宫腔变形的子宫肌瘤的晚育年龄不孕女性的一种有效策略，特别是当应用于在肌瘤切除术前能冷冻至少3个胚胎、肌瘤数量为5个或更少且最大直径小于5 cm的患者时。
