Fortin Chelsea N, Hur Christine, Radeva Milena, Falcone Tommaso
Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic Foundation, 9500 Euclid Ave., Desk A81, Cleveland, OH, 44195, United States.
Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic Foundation, 9500 Euclid Ave., Desk A81, Cleveland, OH, 44195, United States.
J Gynecol Obstet Hum Reprod. 2019 Nov;48(9):751-755. doi: 10.1016/j.jogoh.2019.05.001. Epub 2019 May 8.
To determine the effects of fibroids, and their removal, on ART outcomes.
Single institution retrospective cohort study of infertility patients who underwent myomectomy prior to either in vitro fertilization (IVF) or intrauterine insemination (IUI) between August 2006 and October 2015 (N = 49). Two separate control groups were established: 1) women with fibroids left in situ during the ART process (N = 76), and 2) women with no fibroids (N = 103). The study was powered to detect a difference between a 42%, 11%, and 25% live birth (LB) rate in the myomectomy, fibroids in situ, and no fibroids groups at P < 0.05.
There were no significant differences in IVF cycle parameters between groups. Fibroids that were either submucosal or intramural with associated cavity distortion were significantly more likely to be removed. Amongst women undergoing IVF, the cumulative incidence of clinical pregnancy (CP) was significantly higher in the myomectomy group than the in situ or no fibroids groups. Women who underwent pre-IVF myomectomy also achieved CP more quickly. Cumulative LB rates did not differ significantly amongst women undergoing IVF. CP and LB rates per cycle were similar between myomectomy, in situ, and no fibroids groups (CP 49% vs. 37.5% vs. 54.4%, P = 0.21; LB 41.7% vs. 27.1% vs. 43.9%, P = 0.17).
IVF outcomes appear to be improved by judicious removal of clinically significant fibroids. Further prospective studies are required to confirm the role of fibroids, and their removal, on ART outcomes before advocating for routine myomectomy amongst women with fibroids undergoing ART.
确定子宫肌瘤及其切除对辅助生殖技术（ART）结局的影响。
对2006年8月至2015年10月期间在体外受精（IVF）或宫腔内人工授精（IUI）之前接受子宫肌瘤切除术的不孕患者进行单机构回顾性队列研究（N = 49）。设立了两个独立的对照组：1）ART过程中子宫肌瘤未处理的女性（N = 76），2）无子宫肌瘤的女性（N = 103）。该研究旨在检测子宫肌瘤切除组、子宫肌瘤未处理组和无子宫肌瘤组分别为42%、11%和25%的活产（LB）率之间的差异，P < 0.05。
各组间IVF周期参数无显著差异。黏膜下或肌壁间伴有宫腔变形的肌瘤更有可能被切除。在接受IVF的女性中，子宫肌瘤切除组的临床妊娠（CP）累积发生率显著高于子宫肌瘤未处理组或无子宫肌瘤组。接受IVF前子宫肌瘤切除术的女性也更快实现临床妊娠。接受IVF的女性中，累积活产率无显著差异。子宫肌瘤切除组、子宫肌瘤未处理组和无子宫肌瘤组的每个周期CP和LB率相似（CP分别为49%、37.5%和54.4%，P = 0.21；LB分别为41.7%、27.1%和43.9%，P = 0.17）。
明智地切除具有临床意义的子宫肌瘤似乎可改善IVF结局。在提倡对接受ART的子宫肌瘤女性进行常规子宫肌瘤切除术之前，需要进一步的前瞻性研究来证实子宫肌瘤及其切除对ART结局的作用。
