| ObjctiveLeiomyoma is the most common benign tumor in the female reproductive system.They are present in20%-30%of reproductive age women. Except the disease cause menstruation, anemia and compression symptoms outside, it still can cause infertility and abortion. It reported that1%-2.4%of infertility patients with LM. LM patients natural pregnancy rate is only28%, and abortion rate is as high as14%. The treatment of uterine fibroids is mainly drug treatment and surgical treatment, drug treatment cycle is long, and the surgical treatment for traumatic big, postoperative anatomical sex infertility as high as40%. LM affect outcome of in vitro fertilization-embryos transfer.Leiomyoma include submucosal uterine fibroids, Subserosal uterine fibroids and intramural uterine fibroids. At present, the domestic and foreign research shows that submucosal uterine fibroids affect embryos implatation, and reduce the clinical pregnancy rates. It need to be under hysteroscopy myomectomy; Subserosal uterine fibroids no obvious adverse influence on pregnancy, no special treatment; For large intramural uterine fibroids (>5cm) cause uterine deformation oppression of uterine intramural uterine fibroids that surgery was eliminated, and postoperative uterine fibroids can avoid the influence of pregnancy, increase pregnancy rate; Not involving the oppression of uterine lining intramural uterine fibroids on pregnancy without the influence of the exact definitions, and that there is a wide controversy.Whether small intramural uterine fibroids effect outcome of assisted reproductive technology, and what is mechanisms leading to poor treatment outcome. It advance and whether it is worth discussing the surgical treatment for pregnancy outcome. All kinds of uterine fibroids effects clinical pregnancy rates by the endometrial receptivity. Using ultrasound technology test endometrial thickness, types, volume and hemodynamic parameters to evaluade endometrial receptivity, because it is simple, repetition and noninvasive in recent years, small intramural uterine fibroids is also influence endometrial receptivity? What kind of small intramural uterine fibroids effects endometrial receptivity? The center by transvaginal three-dimensional ultrasound determination in vitro fertilization-embryo transfer(IVF-ET) cycle medium and small intramural fibroids infertile patients uterine fibroids and lining the blood flow parameters, with and without fibroids infertile patients compared, discusses small intramural fibroids for in vitro fertilization-embryo transfer the pregnancy outcome the effects for small intramural fibroid treatment of choice to provide the reference.Materials and MethodsSelect from January in2010to October in2011accept IVF-ET treatment of infertility patients in my center? An example, divided into two groups:the team: according to the history and auxiliary examination as intramural fibroids diagnostic criteria no myomectomy history,4cm in diameter without oppression of the deformation of the uterine lining not make intramural fibroids patients; The control group:no uterine fibroids patients all patients exclude other system disease and endometriosis chromosome abnormalities of the influence factors of the pregnancy outcomeAll received a long protocol of pituitary downregulation as previously described: after GnRH-a downregulation, received follicle-stimulating hormone (FSH) levels until follicles are mature. Then after HCG injection36-37hours under transvaginal ultrasound detection do oocytes retrival, oocytes by in vitro fertilization and short-term fertilization, and take2-3days embryo ongoing embryo transfer, after transplantation14and18days test blood and urine HCG level, and in35days do abdominal ultrasound within Gestation sacs in clinic pregnancy. Collecting venous blood (fasting) of all the patients. Use the completely automatic analyzer to measure the electrochemical luminescence FSH, LH, E2, P level. Measure all of the patients in the oocytes number, Gn days, Gn level, two PN fertility rate, cleavege rate, good embryos rate, implatation rate, adoption rate and clinical pregnancy rate. Use America Voluson-RealTime4DTM real-time color doppler ultrasound observation of fibroids number, position and the lining of the uterus relationship, determination and the size of endometriosis patients fibroids with baseline (lining strong echo and sound dizzy border) the vertical distance of the shortest, determination thickness endometrial of ET day, uterine pulsatility index(PI)/resistance index(RI) endrometrial and subendometrial vascularization index(Ⅵ)、flow index(FI)、 vascularization flow index(VFI), respectively in the group and comparison between groups, and the statistical analysis.Result1. Endometrial thickness on the day of embryo transfer in group of small intramural uterine fibroids was significantly less than that in control group(P<0.05). Good quality embryo rate、implantation rate in group of small intramural uterine fibroids was significantly less than that in control group(P<0.05). Abortion rate in group of small intramural uterine fibroids was significantly higher than that in control group(P<0.05). clinical pregnancy rate was less than that in control group, but it is not significant(P>0.05).2. According to distance from small intramural uterine fibroids to endometriosis Endometrial FI was significantly higher in group of D≤lmm than that of other groups(P<0.05). Implantation rate was significantly higher in group of D≤lmm than that of group of D>3mm(P<0.05). 3. In small intramural uterine fibroids what did not damage uterine cavity: implantation rate、clinical pregnancy rate and abortion rate was not significant in single or multiple intramural uterine fibroids and same in diameter<20mm or≥20mm(P>0.05).4. In patients of pregnant and nonpergnant:Endometrial thickness on the day of embryo transfer、endometrial volume on the day of embryo transfer、uterine PI、RI and endometrial FI was significantly higher in pregnant group of small intramural uterine fibroids than that in nonpergnant group(P>0.05). Endometrial thickness on the day of embryo transfer、endometrial volume on the day of embryo transfer and uterine PI、RI was significantly higher in pregnant group of control than that in nonpergnant group(P>0.05).Conclusion1. Small intramural uterine fibroids influence pregnancy outcome in patients with IVF treatment; and noninfluence endometrial and subendometrial blood flow.2. And the closer the lining of the small intramural uterine fibroids planting rate is high, may relevant with endometrial riched FI.3. Not that the deformation of uterine small intramural uterine fibroids, uterine fibroids number and the size of the pregnancy outcome IVF treatment unrelated.4. Endometrial thickness, endometrial volume, uterine artery PI, RI and endometrial FI joint may be able to predict the pregnancy outcome IVF treatment. |
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