子宫肌瘤与不孕症相关性评估

Assessment of uterine fibroids and infertility

子宫肌瘤与不孕症的关系与肌瘤的位置有关。不孕症妇女子宫肌瘤治疗的指南尚缺乏强有力的证据。浆膜下肌瘤基本不影响受孕和妊娠结局。黏膜下子宫肌瘤对生育不利影响显著,妊娠率降低,流产率升高。子宫肌壁间肌瘤对受孕的影响主要与肌瘤是否改变宫腔形态及肌瘤的大小有关,改变宫腔形态及有明显临床症状的子宫肌瘤建议手术切除。如果肌瘤直径>4cm、距离内膜<5mm,反复着床失败并且没有找到其他原因,也可行肌瘤剔除术。但手术及方法的选择应基于患者的意愿、病史、完善的检查以及医生的技术。

The question of whether the existence of a fibroid is causally related to a couple＇ s infertility depends on its location and the existence of other factors that may explain the inability to conceive. Clinicians working with infertile patients should be aware that the evidence guiding the management of uterine fibroids is generally not strong. Subserosal fibroids do not appear to have a significant effect on fertility outcomes. Submucosal fibroids may be associated with reduced fertility and an increased Miscarriage Rate. Intramural fibroids may be associated with reduced fertility and an increased miscarriage rate. Fibroids that distort the uterine cavity should be removed, irrespective whether they are submueous or intramural. Intramural fibroids do not significantly affect outconies of IVF -ET with the exception larger fibroids （ 〉 4 cm） located in close proximity （ 5 mm） to the endometrial cavity.