超過2cm子宮肌瘤對胚胎著床率有不良影響

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Fertil Steril. 2018 Mar 28. pii: S0015-0282(18)30007-4. doi: 10.1016/j.fertnstert.2018.01.007. [Epub ahead of print]

Effect of type 3 intramural fibroids on in vitro fertilization-intracytoplasmic sperm injection outcomes: a retrospective cohort study.

Yan L1, Yu Q1, Zhang YN1, Guo Z1, Li Z1, Niu J1, Ma J2.

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Abstract

OBJECTIVE:

To evaluate the influence of type 3 intramural fibroids on in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) outcomes.

DESIGN:

Retrospective cohort study.

SETTING:

University-based reproductive medicine center.

PATIENT(S):

All women undergoing IVF-ICSI from January 1, 2009, to December 31, 2016, in our unit.

INTERVENTION(S):

Each woman was matched with three separate control subjects of the same age (±1 year), number of cycles, type of infertility (primary or secondary), type of protocol used for controlled ovarian hyperstimulation (COH), and no uterine fibroids identified by transvaginal ultrasound.

MAIN OUTCOME MEASURE(S):

Implantation, clinical pregnancy, clinical miscarriage, and live birth rates.

RESULT(S):

We included 151 patients with type 3 intramural fibroids and 453 matched control subjects who underwent IVF-ICSI. The rate of "other protocol" used in COH was significantly higher in women with type 3 fibroids than in the control subjects (P<.001). The experimental group had a significantly lower implantation rate. Type 3 fibroids also resulted in a lower frequency of live births and clinical pregnancy. There was no significant difference between the groups in the rate of clinical miscarriage. Compared with the corresponding control subjects, patients with type 3 fibroids with a single fibroid diameter (SD) or total reported fibroid diameter (TD) >2.0 cm also had significantly lower rates of live birth, clinical pregnancy, and implantation. Type 3 fibroids with SD or TD ≤2.0 cm had no significant difference in IVF-ICSI outcomes compared with corresponding control subjects.

CONCLUSION(S):

Our results suggest that type 3 fibroids exert a negative impact on the rates of implantation, clinical pregnancy, and live birth in patients undergoing IVF-ICSI, but do not significantly increase the clinical miscarriage rate. The deleterious impact of type 3 fibroids was remarkable in women with type 3 fibroids with TD or SD >2.0 cm.