Yohei Kishi1, Maki Yabuta2, Fumiaki Taniguchi2. 1. Department of Obstetrics and Gynecology, Takanohara Central Hospital, Nara, Japan. Electronic address: kishi@takanohara-ch.or.jp. 2. Department of Obstetrics and Gynecology, Takanohara Central Hospital, Nara, Japan.
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.
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: Maria Szubert; Edward Koziróg; Olga Olszak; Klaudia Krygier-Kurz; Jakub Kazmierczak; Jacek Wilczynski Journal: Int J Environ Res Public Health Date: 2021-01-30 Impact factor: 3.390