Farhi J, Ashkenazi J, Feldberg D, Dicker D, Orvieto R, Ben Rafael Z
Department of Obstetrics and Gynecology, Golda Medical Center, Hasharon Hospital, Petah Tikva, Israel.
Hum Reprod. 1995 Oct;10(10):2576-8. doi: 10.1093/oxfordjournals.humrep.a135748.
The effect of uterine leiomyoma on infertility is subject to controversy. Two main mechanisms associating leiomyomata and infertility have been suggested: the obstruction of gamete transport and impaired implantation. In-vitro fertilization (IVF) is a unique setting for examining the effect of leiomyomata on the implantation rate. This study was designed to determine the impact of uterine leiomyomata on the results of IVF. In a retrospective analysis of IVF cycles, 46 women with documented uterine leiomyoma were compared with a control group with mechanical infertility. The implantation rate and pregnancy outcome in relation to the leiomyoma were observed. Implantation (22.1%/transfer, 6.8%/embryo) and abortion rates (36%) in the study group were similar to the results in the control group with pure mechanical factor. An analysis of IVF results according to the hysteroscopic pretreatment findings revealed that impaired implantation is associated with leiomyoma only where uterine intracavitary abnormalities co-exist. We conclude that implantation rate and pregnancy outcome are impaired in women with uterine leiomyomata only when they cause deformation of the uterine cavity. In patients with leiomyomata associated with an abnormal uterine cavity, surgical treatment should be considered prior to IVF because of the reduced implantation rate.
子宫平滑肌瘤对不孕的影响存在争议。已提出两种将平滑肌瘤与不孕相关联的主要机制：配子运输受阻和着床受损。体外受精（IVF）是检验平滑肌瘤对着床率影响的独特环境。本研究旨在确定子宫平滑肌瘤对IVF结果的影响。在一项对IVF周期的回顾性分析中，将46例有子宫平滑肌瘤记录的女性与一组机械性不孕的对照组进行比较。观察了与平滑肌瘤相关的着床率和妊娠结局。研究组的着床率（每次移植22.1%，每个胚胎6.8%）和流产率（36%）与单纯机械因素对照组的结果相似。根据宫腔镜预处理结果对IVF结果进行的分析显示，只有在子宫腔内异常同时存在时，着床受损才与平滑肌瘤相关。我们得出结论，子宫平滑肌瘤女性只有在导致子宫腔变形时，着床率和妊娠结局才会受损。对于伴有子宫腔异常的平滑肌瘤患者，由于着床率降低，在IVF前应考虑手术治疗。
