Who will benefit from uterus sparing surgery in adenomyosis associated subfertility

This retrospective cohort study demonstrates the advantage of younger age for substantial benefits from uterus-sparing surgery in women with adenomyosis-associated subfertility.

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Authors

Yohei Kishi, M.D., Maki Yabuta, M.D., Fumiaki Taniguchi, M.D.

Volume 102, Issue 3, Pages 802-807

Abstract

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.

Read the full text at: http://www.fertstert.org/article/S0015-0282(14)00491-9/fulltext


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Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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