Vincent Department of Obstetrics and Gynecology, Reproductive Medicine and IVF, Massachusetts General Hospital, Boston MA, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston MA, USA.
Infertility and In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel-Hashomer) and The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel Aviv, Israel.
Reprod Biomed Online. 2019 Sep;39(3):484-491. doi: 10.1016/j.rbmo.2019.04.130. Epub 2019 May 7.
Which factors are associated with reproductive outcomes among infertile women undergoing myomectomy for intramural fibroids?
This was a historical cohort study including 127 infertile women who underwent myomectomy due to intramural fibroids as part of fertility enhancement treatment at a single academic tertiary-care medical centre between the years 2011 and 2015. Demographic characteristics, pre-operative evaluation, surgical factors and post-surgical factors were compared between women who successfully conceived and those who did not following myomectomy.
The overall clinical pregnancy rate following myomectomy was 58.3% (n = 74). Women with successful conception were significantly younger (35.4 ± 4.5 years versus 37.2 ± 4.0 years; P = 0.022), and mostly white (63.5% versus 24.3% African-American; P = 0.008). In addition, patients who conceived had larger fibroids demonstrated in pre-operative imaging and during surgery (7.3 versus 6.1 cm and 7.8 versus 6.6 cm; P = 0.003 and 0.022, respectively), with fewer cases of cavity entry determined during surgery (9.5% versus 28.3%; P = 0.005). Multivariable modified Poisson regression models identified the patient's age (risk ratio [RR] 0.96, 95% confidence interval [CI] 0.93-0.99; P =0.014) and race (RR for African-American women versus white women 0.58, 95% CI 0.38-0.88; P = 0.011) as factors significantly associated with the probability of conceiving following myomectomy.
CONCLUSION(S): Age and race play a significant role in the reproductive outcomes of infertile women undergoing intramural fibroid myomectomy as part of fertility enhancement treatment. Further large prospective studies are needed to identify specific factors associated with achieving pregnancy, which will help to determine the clinical management of infertile women with intramural fibroids.
接受子宫肌瘤切除术治疗子宫壁肌瘤的不孕女性的生殖结局与哪些因素相关？
这是一项回顾性队列研究，纳入了 2011 年至 2015 年期间在一家学术性三级医疗中心因子宫壁肌瘤接受子宫肌瘤切除术以增强生育能力的 127 名不孕女性。比较了子宫肌瘤切除术后成功受孕和未受孕的女性之间的人口统计学特征、术前评估、手术因素和术后因素。
子宫肌瘤切除术后的总临床妊娠率为 58.3%（n=74）。成功受孕的女性明显更年轻（35.4±4.5 岁比 37.2±4.0 岁；P=0.022），且大多为白人（63.5%比 24.3%为非裔美国人；P=0.008）。此外，受孕患者术前影像学检查和术中显示肌瘤更大（7.3 厘米比 6.1 厘米和 7.8 厘米比 6.6 厘米；P=0.003 和 0.022），术中确定的宫腔进入病例更少（9.5%比 28.3%；P=0.005）。多变量修正泊松回归模型确定了患者的年龄（风险比[RR]0.96，95%置信区间[CI]0.93-0.99；P=0.014）和种族（非裔美国女性与白人女性的 RR 为 0.58，95%CI 0.38-0.88；P=0.011）是与子宫肌瘤切除术后受孕概率显著相关的因素。
年龄和种族在作为生育增强治疗一部分接受子宫壁肌瘤切除术的不孕女性的生殖结局中起着重要作用。需要进一步开展大型前瞻性研究来确定与妊娠相关的具体因素，这将有助于确定患有子宫壁肌瘤的不孕女性的临床管理。
