Higgins Chloe, Fernandes Hugo, Da Silva Costa Fabricio, Martins Wellington P, Vollenhoven Beverley, Healey Martin
Women's and Newborn Programme, Monash Health, Clayton, VIC, Australia.
Newlife IVF, Box Hill, VIC, Australia.
Hum Reprod Open. 2021 Apr 19;2021(2):hoab015. doi: 10.1093/hropen/hoab015. eCollection 2021.
Does the presence of adenomyosis in women treated with IVF alter IVF outcomes?
Adenomyosis does not significantly alter IVF outcomes when adjusted for confounding factors including maternal age and smoking status.
Studies evaluating adenomyosis and its impact on infertility, particularly when focusing on IVF, remain controversial. Many studies report that adenomyosis has a detrimental effect on IVF outcomes, however age is strongly related with both the prevalence of adenomyosis and worse reproductive outcomes.
A prospective cohort study of women undergoing 4002 IVF cycles who had undergone a screening ultrasound assessing features of adenomyosis from 1 January 2016 to 31 March 2018 at a multi-site private fertility clinic. Of these women, 1228 fulfilled the inclusion criteria and commenced an IVF cycle, with a subset of 715 women undergoing an embryo transfer (ET). Women were defined as having adenomyosis if there was sonographic evidence of adenomyosis on ultrasound as per the Morphological Uterus Sonographic Assessment criteria, and were then compared to women without.
PARTICIPANTS/MATERIALS SETTING METHODS: All women at a private multi-site IVF clinic who underwent a standardised ultrasound to identify features of adenomyosis and also commenced an IVF cycle were assessed for their outcomes. These included clinical pregnancy (defined as the presence of a gestational sac on ultrasound at 7 weeks' gestation), clinical pregnancy loss, number of cancelled cycles, number of useful embryos for transfer or freezing and live birth rates. As a secondary aim, initiated stimulation cycles and those that had an ET were analysed separately to determine when an effect of adenomyosis on IVF might occur: during stimulation or transfer.
When adjusting for confounders, women with and without sonographic features of adenomyosis had no significant differences in most of their IVF outcomes including live birth rates.
Adenomyosis had a detrimental impact on IVF outcomes prior to adjusting for confounding factors. No allowance was made for the possibility that confounding factors may merely reduce the effect size of adenomyosis on IVF outcomes. Second, despite a power calculation, the study was underpowered as not all fresh cycles led to an ET.
This is one of the largest studies to evaluate adenomyosis and IVF outcomes, while also importantly adjusting for confounding factors. The results suggest that adenomyosis does not have the detrimental impact on IVF that has previously been suggested, possibly reducing the importance of screening for and treating this entity.
STUDY FUNDING/COMPETING INTERESTS: The study received no external funding. The authors declare no conflicts of interest.
ACTRN12617000796381.
接受体外受精（IVF）治疗的女性患有子宫腺肌病是否会改变IVF结局？
在对包括产妇年龄和吸烟状况等混杂因素进行调整后，子宫腺肌病不会显著改变IVF结局。
评估子宫腺肌病及其对不孕症影响的研究，尤其是聚焦于IVF的研究，仍存在争议。许多研究报告称子宫腺肌病对IVF结局有不利影响，然而年龄与子宫腺肌病的患病率以及较差的生殖结局均密切相关。
研究设计、规模、持续时间：一项前瞻性队列研究，研究对象为2016年1月1日至2018年3月31日在一家多站点私立生育诊所接受4002个IVF周期治疗且已接受超声筛查以评估子宫腺肌病特征的女性。在这些女性中，1228名符合纳入标准并开始了IVF周期，其中715名女性进行了胚胎移植（ET）。根据子宫形态超声评估标准，超声检查有子宫腺肌病超声证据的女性被定义为患有子宫腺肌病，然后与未患该病的女性进行比较。
参与者/材料、环境、方法：对一家私立多站点IVF诊所中所有接受标准化超声检查以识别子宫腺肌病特征并开始IVF周期的女性的结局进行评估。这些结局包括临床妊娠（定义为妊娠7周时超声检查发现妊娠囊）、临床妊娠丢失、取消周期数、可用于移植或冷冻的有效胚胎数以及活产率。作为次要目的，分别分析启动的刺激周期和进行了ET的周期，以确定子宫腺肌病对IVF的影响可能发生在何时：刺激期间还是移植期间。
在对混杂因素进行调整后，有和没有子宫腺肌病超声特征的女性在大多数IVF结局（包括活产率）方面没有显著差异。
局限性、谨慎的原因：在对混杂因素进行调整之前，子宫腺肌病对IVF结局有不利影响。未考虑混杂因素可能只是减小了子宫腺肌病对IVF结局的效应大小这种可能性。其次，尽管进行了功效计算，但该研究的功效不足，因为并非所有新鲜周期都导致了ET。
这是评估子宫腺肌病和IVF结局的最大规模研究之一，同时重要的是对混杂因素进行了调整。结果表明，子宫腺肌病对IVF并没有之前所认为的不利影响，这可能降低了筛查和治疗该疾病的重要性。
研究资金/利益冲突：该研究未获得外部资金。作者声明无利益冲突。
ACTRN12617000796381。
