目的:小且无症状的壁内和浆膜下子宫肌瘤是否会影响女性生育能力?
结论:小且无症状的肌瘤如果不侵占子宫内膜腔,似乎不会明显影响女性生育能力。
背景:关于子宫肌瘤和生育能力的现有证据有限。通过比较受子宫肌瘤影响和未受影响的女性的成功,在IVF设置中获得了大多数信息。这些研究已经显示了粘膜下和可能的壁内肌瘤的有害作用。然而,本研究设计仅提供有关胚胎植入的信息,不是一般的女性生育能力。
UNASSIGNED:对200名伴侣被诊断为严重男性不育症的女性和200名不明原因不育症的女性进行了回顾性观察性病例对照研究。如果零假设(肌瘤不影响生育能力)是有效的,在这两个研究组中,我们预计肌瘤的患病率相似。相反,如果子宫肌瘤影响生育,人们预计不明原因不孕症女性的患病率会更高。这项研究是在FondazioneIRCCSCa\'GrandaOspedaleMaggiorePoliclinico的不孕症部门进行的,为期5年,从2014年1月到2020年6月。
方法:我们回顾性招募了寻求妊娠的女性,其伴侣的精子浓度被反复证实低于100万/毫升,并根据年龄和研究时间与一组原因不明的不孕妇女进行匹配。后一组妇女被认为是一个病例组(不育受试者),而前一组妇女被视为对照组(反映了一般女性人口)。患有肌瘤的女性可以被包括在两个研究组中;只有粘膜下病变的女性被排除在外。
结果:31名女性(16%)患有无法解释的不育症,32名女性(16%)患有严重男性因素不育症。患有不明原因不孕症的女性患有肌瘤的校正比值比为0.91(95%CI:0.52-1.58)。根据数量进行亚组分析,子宫肌瘤的大小和位置未能突出显示任何组的不孕风险增加。
结论:这是一项回顾性研究,不能排除肌瘤检测中的一些不准确之处。此外,相对较小的样本量妨碍了稳健的亚组分析.即使我们排除了有不孕症专利原因的女性,一些特定原因导致不孕症的女性可能被纳入对照组(但预计将占该组的<10%).
结论:本研究提示不侵犯子宫内膜腔的小肌瘤对女性生育能力无明显影响。当咨询患有小肌瘤的不育妇女和其他不明显的诊断检查时,此信息具有临床相关性。手术仍可考虑,但只能在选定的病例中考虑。
背景:这项研究部分由意大利卫生部资助:目前的研究IRCCS。E.S.报告了费林的赠款,默克公司的赠款和个人费用,以及Theramex在提交的作品之外的赠款和个人费用。所有其他作者都没有任何竞争利益需要声明。
背景:不适用。
OBJECTIVE: Do small and asymptomatic intramural and subserosal uterine fibroids affect female fertility?
CONCLUSIONS: Small and asymptomatic fibroids that do not encroach the endometrial cavity appear to not markedly affect female fertility.
BACKGROUND: The available evidence on uterine fibroids and fertility is limited. Most information has been obtained in IVF settings by comparing the success in women affected and not affected by fibroids. These studies have shown a detrimental effect of submucosal and possibly intramural fibroids. However, this
study design provides information only on embryo implantation, not on female fertility in general.
UNASSIGNED: A retrospective observational case-control
study on 200 women whose partner was diagnosed with severe male infertility and 200 women with unexplained infertility was conducted. If the null hypothesis (that fibroids do not affect fertility) is valid, one would expect a similar prevalence of fibroids in the two study groups. Conversely, if fibroids do impact fertility, one would expect a higher prevalence among women with unexplained infertility. The
study was carried out at the Infertility Unit of the Fondazione IRCCS Ca\' Granda Ospedale Maggiore Policlinico covering a 5-year period between January 2014 and June 2020.
METHODS: We retrospectively recruited women seeking pregnancy whose partner was repeatedly documented to have a sperm concentration below 1 million/ml and matched them by age and study period to a group of women with unexplained infertility. The latter group of women was considered as a case group (infertile subjects), while the former group of women was considered as a control group (reflecting the general female population). Women with fibroids could be included in both study groups; only those with submucosal lesions were excluded.
RESULTS: Fibroids were diagnosed in 31 women (16%) with unexplained infertility and in 32 women (16%) with severe male factor infertility. The adjusted odds ratio of carrying fibroids in women with unexplained infertility was 0.91 (95% CI: 0.52-1.58). Subgroup analyses according to number, dimension and location of fibroids failed to highlight an increased risk of infertility in any group.
CONCLUSIONS: This is a retrospective study and some inaccuracies in fibroids detection cannot be ruled out. Moreover, the relatively small sample size hampers robust subgroup analyses. Even though we excluded women with patent causes of infertility, some women with specific causes of infertility could have been included among controls (yet are expected to account for <10% of the group).
CONCLUSIONS: This
study suggests that small fibroids that do not encroach the endometrial cavity do not markedly affect female fertility. This information is clinically relevant when counseling infertile women with small fibroids and an otherwise unremarkable diagnostic work-up. Surgery may still be considered but only in selected cases.
BACKGROUND: This
study was partially funded by Italian Ministry of Health: current research IRCCS. E.S. reports grants from Ferring, grants and personal fees from Merck, and grants and personal fees from Theramex outside the submitted work. All the other authors do not have any competing interest to declare.
BACKGROUND: N/A.