子宫腺肌病对生育的影响和治疗选择

Impact of adenomyosis on fertility and the choice of management

子宫腺肌病是不孕人群的高发疾病,不论是否合并子宫内膜异位症都影响辅助生殖结局。子宫腺肌病影响生殖功能的机制包括:解剖结构异常、子宫异常蠕动、胚胎种植环境改变、宫腔内自由基过多和免疫系统过度激活等。辅助生殖技术可有效的促进妊娠方式,保守性手术在缓解症状的同时也对自然妊娠有益。实施保守性手术前应考虑术后的产科并发症。促性腺激素释放激素激动剂通常作为其他治疗方式的辅助措施。高强度超声聚焦病灶消融的有效性和安全性尚待证实。

Adenomyosis has high prevalence in infertility women,deteriorating the pregnancy results of in vitro fertilization therapy for couples with or without pelvic endometriosis.The mechanisms of effect include:anatomical distortion,uterine dysperistalsis,altered implantation environment,intrauterine free radicals excess and overactive immune system,etc.Assisted reproductive technology is an effective measure to improve the pregnancy outcome,and conservative surgery adds up some natural conception while alleviating the symptoms.Obstetric complications should be taken into account before cytoreductive surgery.Gonadotropin releasing hormone agonist is usually combined with other therapies.Robust evidence is needed for the reproductive effect and safety of high intensity focused ultrasound ablation.