Şükür Y E, Saridogan E
University College London Hospital, London, United Kingdom.
Current address: Ankara University School of Medicine, Department of Obstetrics and Gynaecology, Ankara, Turkey.
Facts Views Vis Obgyn. 2021 Jan 8;12(4):283-289.
To assess the effects of multiple myomectomy at laparotomy on fertility potential of infertile women who are planning to undergo assisted reproductive technology (ART) treatment.
A retrospective single centre cohort study was conducted. Data of infertile women who were planning to undergo ART and underwent open myomectomy for multiple fibroids between January 2010 and December 2018 were reviewed. Data were collected on demographics, presenting symptoms, preoperative imaging findings, operative details, and postoperative and IVF outcomes. The primary outcome measure was the necessity for further hysteroscopic surgery prior to subsequent in vitro fertilisation (IVF) cycle. The secondary outcome measure was live birth rate.
A total of 55 women were included in the analyses. The median number of fibroids removed was 12 (range, 3-51). Thirteen (26%) women required further surgery before embryo transfer. In women with a breached endometrial cavity, the likelihood of further hysteroscopic division of intrauterine adhesions was increased 18-fold (P=0.017). Thirty-two women underwent 45 IVF cycles, 16 of which resulted in live birth (50%).
Infertile women with large and multiple fibroids could have good fertility outcomes following open myomectomy. Special care must be taken not to damage the uterine cavity. The intraoperative breach of the endometrial cavity seems to increase the risk of intrauterine adhesions, which may further compromise ART treatment and outcomes. Hysteroscopy prior to any embryo transfer cycle may help to optimise the endometrial cavity and fertility outcome in women who underwent multiple myomectomy.
评估开腹多发性子宫肌瘤切除术对计划接受辅助生殖技术（ART）治疗的不孕女性生育潜能的影响。
进行一项回顾性单中心队列研究。回顾了2010年1月至2018年12月期间计划接受ART且因多发性子宫肌瘤接受开腹子宫肌瘤切除术的不孕女性的数据。收集了人口统计学、临床表现、术前影像学检查结果、手术细节以及术后和体外受精（IVF）结果的数据。主要结局指标是在随后的体外受精（IVF）周期之前是否需要进一步的宫腔镜手术。次要结局指标是活产率。
共有55名女性纳入分析。切除的肌瘤中位数为12个（范围3 - 51个）。13名（26%）女性在胚胎移植前需要进一步手术。子宫内膜腔破裂的女性，进一步宫腔镜分离宫腔粘连的可能性增加了18倍（P = 0.017）。32名女性进行了45个IVF周期，其中16个周期活产（50%）。
患有大的多发性肌瘤的不孕女性在开腹子宫肌瘤切除术后可能有良好的生育结局。必须特别注意避免损伤子宫腔。术中子宫内膜腔破裂似乎会增加宫腔粘连的风险，这可能会进一步影响ART治疗及其结局。在任何胚胎移植周期之前进行宫腔镜检查可能有助于优化接受多发性子宫肌瘤切除术女性的子宫内膜腔和生育结局。
