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Who will benefit from uterus-sparing surgery in adenomyosis-associated subfertility?
MedLine Citation:
PMID:  24954774     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: To analyze the determinants of successful pregnancy following laparoscopic adenomyomectomy.
DESIGN: Retrospective cohort study.
SETTING: A general hospital.
PATIENT(S): A total of 102 women who had a desire for pregnancy underwent laparoscopic adenomyomectomy from 2007 to 2012.
INTERVENTION(S): Surgical excision of the uterine adenomyosis; statistical analysis for fertility outcomes.
MAIN OUTCOME MEASURE(S): Pregnancy rates and the results of univariable and multivariable analyses.
RESULT(S): When the women were divided into ≤39 years and ≥40 years age groups, clinical pregnancy rates were 41.3% and 3.7%, respectively. Factors associated with clinical pregnancy were: history of IVF treatments, posterior wall involvements, and age, with odds ratios of 6.22, 0.18, and 0.77, respectively. In the younger group, 60.8% of women with history of IVF failure showed successful pregnancy after surgery. We experienced 2 cases of placenta accreta in far advanced cases.
CONCLUSION(S): This study demonstrated age as a determinant in fertility outcomes. Surgery could be a beneficial treatment for women who experienced IVF treatment failures, especially at ages of ≤39 years. We could not show a clear benefit of the surgery on fertility outcomes of the group aged ≥40 years. Extremely severe adenomyosis affecting a broad range of the uterine subendomerial myometrium should be treated carefully on a pregnancy course.
Authors:
Yohei Kishi; Maki Yabuta; Fumiaki Taniguchi
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-6-19
Journal Detail:
Title:  Fertility and sterility     Volume:  -     ISSN:  1556-5653     ISO Abbreviation:  Fertil. Steril.     Publication Date:  2014 Jun 
Date Detail:
Created Date:  2014-6-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372772     Medline TA:  Fertil Steril     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
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