Intramural Leiomyomas and Fertility

医学 平滑肌瘤 怀孕 优势比 产科 科克伦图书馆 活产 生育率 纳入和排除标准 子宫肌瘤 妇科 荟萃分析 人口 内科学 放射科 病理 替代医学 环境卫生 生物 遗传学
作者
Taïna Laurore Pritts,Meghan Ogden,William H. Parker,Jennifer Ratcliffe,Elizabeth A. Pritts
出处
期刊:Obstetrics & Gynecology [Lippincott Williams & Wilkins]
标识
DOI:10.1097/aog.0000000000005661
摘要

OBJECTIVE: To evaluate fertility outcomes based on size and number of intramural leiomyomas and outcomes after removal. DATA SOURCES: Online searches: MEDLINE, ClinicalTrials.gov, PubMed, Cochrane Library, and PROSPERO Library from 1994 to 2023. METHODS OF STUDY SELECTION: A total of 5,143 studies were identified, with inclusion of 13 study groups. TABULATION, INTEGRATION AND RESULTS: Outcomes for size and number of leiomyomas were reported with clinical pregnancy rates and ongoing pregnancy or live-birth rates. In data sets with maximum leiomyoma diameters of less than 6 cm for study inclusion, women with leiomyomas smaller than 3 cm had lower clinical pregnancy rates than women without leiomyomas, with an odds ratio (OR) of 0.53 (95% CI, 0.38–0.76) and, for ongoing pregnancy or live-birth rates, an OR of 0.59 (95% CI, 0.41–0.86). The ORs for clinical pregnancy rates in women with intermediately-sized leiomyomas (those between 3 cm and 6 cm) were lower than in women without leiomyomas, with an OR at 0.43 (95% CI, 0.29–0.63) and, for ongoing pregnancy or live-birth rates, an OR at 0.38 (95% CI, 0.24–0.59). In data sets without exclusion for women with larger-sized leiomyomas, clinical pregnancy rates were lower for those with leiomyomas smaller than 5 cm compared with those without leiomyomas, with an OR of 0.75 (95% CI, 0.58–0.96). Women with leiomyomas larger than 5 cm showed no differences in clinical pregnancy rate compared with women without leiomyomas, with an OR of 0.71 (95% CI, 0.32–1.58). Although women with a single leiomyoma in any location had no differences in outcomes, those with more than one leiomyoma had lower clinical pregnancy rates and ongoing pregnancy or live-birth rates, with an OR of 0.62 (95% CI, 0.44–0.86) and 0.57 (95% CI, 0.36–0.88), respectively. The clinical pregnancy rate for women undergoing myomectomy for intramural leiomyomas was no different than those with intramural leiomyomas in situ, with an OR of 1.10 (95% CI, 0.77–1.59). CONCLUSION: Even small intramural leiomyomas are associated with lower fertility; removal does not confer benefit. Women with more than one leiomyoma in any location have reduced fertility.
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