Faculté de Médecine, Université de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire, Paris, France; Department 3I "Infection, Immunité et inflammation," Institut Cochin, INSERM U1016, Paris, France; Department of Gynaecology Obstetrics and Reproductive Medicine, Hopital Port Royal Cochin, Paris, France.
Faculté de Médecine, Université de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire, Paris, France; Department 3I "Infection, Immunité et inflammation," Institut Cochin, INSERM U1016, Paris, France; Department of Gynaecology Obstetrics and Reproductive Medicine, Hopital Port Royal Cochin, Paris, France.
Fertil Steril. 2020 Dec;114(6):1271-1277. doi: 10.1016/j.fertnstert.2020.06.018. Epub 2020 Aug 28.
To study the association between adenomyosis and infertility, according to the adenomyosis phenotype as diagnosed by magnetic resonance imaging (MRI).
A single-center, cross-sectional study.
University hospital-based research center.
PATIENT(S): Patients between 18 and 42 years of age who were surgically explored for benign gynecological conditions at our institution between May 2005 and May 2018. Only women with uterine MRIs performed by a senior radiologist were retained for this study.
INTERVENTION(S): Primary and secondary infertile women were compared with women without infertility. In addition, the women were diagnosed according to the MRI findings as having adenomyosis (focal adenomyosis of the outer myometrium [FAOM] and/or diffuse adenomyosis phenotypes) or no adenomyosis.
MAIN OUTCOME MEASURE(S): Primary and secondary infertility-associated factors.
RESULT(S): A total of 496 women were included in the study population. Three groups were compared: a no infertility group (n = 361), a primary infertility group (n = 84), and a secondary infertility group (n = 51). Among them, 248 women did not present adenomyosis lesions and 248 women had a radiological diagnosis of adenomyosis. The presence of FAOM was significantly associated with primary infertility. Diffuse adenomyosis was not found to be associated with infertility. The distribution of endometriosis or leiomyomas was not significantly different between the groups. After a multinomial regression model including the women's age and associated endometriosis or leiomyoma, the presence of FAOM was identified as an independent associated factor of primary infertility (adjusted odds ratio 1.9; 95% confidence interval 1.1-3.3).
CONCLUSION(S): The presence of FAOM was associated with primary infertility. This study opens the door to future clinical and basic studies aimed at better characterization of FAOM and its infertility-related physiopathology.
根据磁共振成像（MRI）诊断的子宫腺肌病表型，研究子宫腺肌病与不孕的关系。
单中心、横断面研究。
大学医院研究中心。
2005 年 5 月至 2018 年 5 月期间在我院因良性妇科疾病接受手术探查的 18 至 42 岁患者。仅保留接受高级放射科医生进行子宫 MRI 的女性进行本研究。
将原发性和继发性不孕女性与无不孕女性进行比较。此外，根据 MRI 结果将女性诊断为患有子宫腺肌病（外肌层局灶性子宫腺肌病[FAOM]和/或弥漫性子宫腺肌病表型）或无子宫腺肌病。
原发性和继发性不孕相关因素。
共纳入 496 名研究人群。比较了三组：无不孕组（n = 361）、原发性不孕组（n = 84）和继发性不孕组（n = 51）。其中，248 名女性无腺肌病病变，248 名女性有放射学诊断的腺肌病。FAOM 的存在与原发性不孕显著相关。弥漫性子宫腺肌病与不孕无关。各组子宫内膜异位症或子宫肌瘤的分布无显著差异。在包括女性年龄和相关子宫内膜异位症或子宫肌瘤的多项回归模型中，FAOM 的存在被确定为原发性不孕的独立相关因素（调整优势比 1.9；95%置信区间 1.1-3.3）。
FAOM 的存在与原发性不孕相关。本研究为进一步研究 FAOM 及其与不孕相关的病理生理学特征开辟了道路。
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