子宫腺肌病合并不孕的治疗

doi:10.6040/j.issn.1671-7554.0.2022.0166

摘要/Abstract

摘要： 子宫腺肌病可导致不孕和流产,可增加体外受精-胚胎移植(IVF-ET)的流产率、降低活产率和临床妊娠率,也增加产科和新生儿相关并发症。经阴道超声已成为子宫腺肌病的一线诊断方法,但需提高诊断率。子宫腺肌病合并不孕症的治疗方法包括药物、手术、介入治疗和辅助生殖助孕治疗等。一般情况下可推荐首选IVF,一般推荐GnRH-a的应用和全胚冷冻策略。针对子宫腺肌病的诊断、非IVF治疗方法的效果、GnRH-a预处理以及鲜胚、冻胚移植比较等问题仍需进行更多研究。

关键词: 子宫腺肌病, 不孕症, 体外受精, 胚胎移植

Abstract: Adenomyosis can cause infertility and miscarriage, increase the miscarriage rate of in vitro fertilization intracytoplasmic sperm injection and embryo transfer(IVF-ET), reduce the live birth rate and clinical pregnancy rate, and increase obstetric and neonatal complications. Transvaginal ultrasound has become the first-line diagnostic method of adenomyosis, but the accuracy needs to be improved. The treatment of adenomyosis complicated with infertility includes drug, surgical, interventional therapy and assisted reproduction therapy, et al. IVF is generally recommended as the first choice, and GnRH-a and freeze-all strategy are also recommended. More research is needed to explore the diagnosis of adenomyosis, efficacy of non-IVF treatment, pretreatment of GnRH-a, and comparison of fresh versus frozen embryo transplantation.

Key words: Adenomyosis, Infertility, In vitro fertilization intracytoplasmic sperm injection, Embryo transfer

中图分类号:

R711.74

颜磊,陈子江. 子宫腺肌病合并不孕的治疗[J]. 山东大学学报 (医学版), 2022, 60(7): 43-47.

YAN Lei, CHEN Zijiang. Treatment of adenomyosis complicated with infertility[J]. Journal of Shandong University (Health Sciences), 2022, 60(7): 43-47.

参考文献

[1] Megan L, Tammy YC, Keith BI. A systematic review of adenomyosis: it is time to reassess what we thought we knew about the disease [J]. J Minim Invasive Gynecol, 2021, 28(3): 644-655.
[2] Younes G, Tulandi T. Effects of adenomyosis on in vitro fertilization treatment outcomes: a meta-analysis [J]. Fertil Steril, 2017, 108(3): 483-490.
[3] Mehasseb MK, Bell SC, Brown L, et al. Phenotypic characterisation of the inner and outer myometrium in normal and adenomyotic uteri [J]. Gynecol Obstet Invest, 2011, 71(4): 217-224.
[4] Fischer CP, Kayisili U, Taylor HS. HOXA10 expressionis decreased in endometrium of women with adenomyosis [J]. Fertil Steril, 2011, 95(3): 1133-1136.
[5] Vannuccini S, Tosti C, Carmona F, et al. Pathogenesis of adenomyosis: an update on molecular mechanisms [J]. Reprod Biomed Online, 2017, 35(5): 592-601.
[6] 王冰玉, 杨阳, 晁岚. TOLL 样受体 4 在 15 例子宫腺肌病中的表达及作用[J]. 山东大学学报(医学版), 2020, 58(6): 47-52. WANG Bingyu, YANG Yang, CHAO Lan. Expression and role of toll-like receptor 4 in adenomyosis[J]. Journal of Shandong university(Health Sciences), 2020,58(6):47-52.
[7] Mavrelos D, Holland TK, ODonovan O, et al. The impact of adenomyosis on the outcome of IVF-embryo transfer [J]. Reprod Biomed Online, 2017, 35(5): 549-554.
[8] Martínez-Conejero JA, Morgan M, Montesinos M, et al. Adenomyosis does not affect implantation, but is associated with miscarriage in patients undergoing oocyte donation [J]. Fertil Steril, 2011, 96(4): 943-950.
[9] Yan L, Ding L, Tang R, et al. Effect of adenomyosis on in vitro fertilization/intracytoplasmic sperm injection outcomes in infertile women: a retrospective cohort study [J]. Gynecol Obstet Invest, 2014, 77(1): 14-18.
[10] Nirgianakis K, Kalaitzopoulos DR, Schwartz ASK, et al. Fertility, pregnancy and neonatal outcomes of patients with adenomyosis: a systematic review and meta-analysis [J]. Reprod Biomed Online, 2021, 42(1): 185-206.
[11] Cozzolino M, Tartaglia S, Pellegrini L, et al. The effect of uterine adenomyosis on IVF outcomes: a systematic review and meta-analysis [J]. Reprod Sci, 2022, 3. doi: 10.1007/s43032-021-00818-6.
[12] 子宫腺肌病伴不孕症诊疗中国专家共识编写组. 子宫腺肌病伴不孕症诊疗中国专家共识[J]. 中华生殖与避孕杂志, 2021, 41(4): 287-295.
[13] 中国医师协会妇产科医师分会子宫内膜异位症专业委员会. 子宫腺肌病诊治中国专家共识[J]. 中华妇产科杂志, 2020, 55(6): 376-383.
[14] Zhang XP, Zhang YF, Shi R, et al. Pregnancy outcomes of infertile women with ultrasound-diagnosed adenomyosis for in vitro fertilization and frozen-thawed embryo transfer [J]. Arch Gynecol Obstet, 2021, 304(4): 1089-1096.
[15] Bazot M, Daraï E. Role of transvaginal sonography and magnetic resonance imaging in the diagnosis of uterine adenomyosis [J]. Fertil Steril, 2018, 109(3): 389-397.
[16] Megan L, Tammy YC, Keith BI. A systematic review of adenomyosis: it is time to reassess what we thought we knew about the disease [J]. J Minim Invasive Gynecol, 2021, 28(3): 644-655.
[17] 盛燕霞, 马彩虹, 杨蕊, 等.不同控制促排卵方案对子宫腺肌病患者体外受精胚胎移植结局的影响[J]. 生殖与避孕, 2010, 30(6): 375-378.
[18] Hou X, Xing J, Shan H, et al. The effect of adenomyosis on IVF after long or ultra-long GnRH agonist treatment [J]. Reprod Biomed Online, 2020, 41(5): 845-853.
[19] Rocha TP, Andres MP, Borrelli GM, et al. Fertility-sparing treatment of adenomyosis in patients with infertility: a systematic review of current options [J]. Reprod Sci, 2018, 25(4): 480-486.
[20] Thalluri V, Tremellen KP. Ultrasound diagnosed adenomyosis has a negative impact on successful implantation following GnRH antagonist IVF treatment [J]. Hum Reprod, 2012, 27(12): 3487-3492.
[21] Lan J, Wu YQ, Wu ZX, et al. Ultra-long GnRH agonist protocol during IVF/ICSI improves pregnancy outcomes in women with adenomyosis: a retrospective cohort study [J]. Front Endocrinol(Lausanne), 2021, 12: 609771. doi:10.3389/fendo.2021.609771.
[22] Li M, Xu L, Zhao H, et al. Effects of artificial cycles with and without gonadotropin-releasing hormone agonist pretreatment on frozen embryo transfer outcomes in patients with adenomyosis [J]. Sci Rep, 2021, 11(1): 19326.
[23] Chen M, Luo L, Wang Q, et al. Impact of gonadotropin-releasing hormone agonist pre-treatment on the cumulative live birth rate in infertile women with adenomyosis treated with IVF/ICSI: a retrospective cohort study [J]. Front Endocrinol(Lausanne), 2020, 11: 318. doi:10.3389/fendo.2020.00318.
[24] Ghobara T, Gelbaya TA, Ayeleke RO. Cycle regimens for frozen-thawed embryo transfer [J]. Cochrane Database Syst Rev, 2017, 7: CD003414
[25] Fábregues F, Balasch J, Creus M, et al. Long-term down-regulation does not improve pregnancy rates in an in vitro fertilization program [J]. Fertil, Steril, 1998, 70(1): 46-51.
[26] Liang Z, Yin M, Ma M, et al. Effect of pretreatment with a levonorgestrel releasing intrauterine system on IVF and vitrified-warmed embryo transfer outcomes in women with adenomyosis [J]. Reprod Biomed Online, 2019, 39(1): 111-118.
[27] Yun BH, Jeon YE, Seo SK, et al. Effects of a levonorgestrel-releasing intrauterine system on the expression of steroid receptor coregulators in adenomyosis [J]. Reproductive sciences, 2015, 22(12): 1539-1548.
[28] Gomes MK, Rosa-e-Silva JC, Garcia SB, et al. Effects of the levonorgestrel-releasing intrauterine system on cell proliferation, Fas expression and steroid receptors in endometriosis lesions and normal endometrium [J]. Human reproduction, 2009, 24(11): 2736-2745.
[29] Tan J, Moriarty S, Taskin O, et al. Reproductive outcomes after fertility-sparing surgery for focal and diffuse adenomyosis: a systematic review [J]. J Minim Invasive Gynecol, 2018, 25(4): 608-621.
[30] Wu YC, Huang JY, Zhong GZ, et al. Long-term GnRH agonist pretreatment before frozen embryo transfer improves pregnancy outcomes in women with adenomyosis [J]. Reprod Biomed Online, 2022, 44(2): 380-388.
[31] Wei D, Liu JY, Sun Y, et al. Frozen versus fresh single blastocyst transfer in ovulatory women: a multicentre, randomised controlled trial [J]. Lancet, 2019, 393(10178): 1310-1318.
[32] Zhu XW, Dongye HJ, Lu SM, et al. Pregnancy outcomes after fresh versus frozen embryo transfer in women with adenomyosis: a retrospective cohort study [J]. Reprod Biomed Online, 2022, 44(6):1023-1029.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed