שאלת המשך לפרופ' אשכנזי בנושא מיומות

יונית שלום להלן המאמר המקורי שלנו בנושא מיומות ו-IVF המדגיש את העובדה שמיומות המעוותות את חלל הרחם מפחיתות את סיכויי ההריון ונדרשות לטיפול כירורגי מקדים Hum Reprod. 1995 Oct;10(10):2576-8. Effect of uterine leiomyomata on the results of in-vitro fertilization treatment. Farhi J, Ashkenazi J, Feldberg D, Dicker D, Orvieto R, Ben Rafael Z. Source Department of Obstetrics and Gynecology, Golda Medical Center, Hasharon Hospital, Petah Tikva, Israel. Abstract The effect of uterine leiomyoma on infertility is subject to controversy. Two main mechanisms associating leiomyomata and infertility have been suggested: the obstruction of gamete transport and impaired implantation. In-vitro fertilization (IVF) is a unique setting for examining the effect of leiomyomata on the implantation rate. This study was designed to determine the impact of uterine leiomyomata on the results of IVF. In a retrospective analysis of IVF cycles, 46 women with documented uterine leiomyoma were compared with a control group with mechanical infertility. The implantation rate and pregnancy outcome in relation to the leiomyoma were observed. Implantation (22.1%/transfer, 6.8%/embryo) and abortion rates (36%) in the study group were similar to the results in the control group with pure mechanical factor. An analysis of IVF results according to the hysteroscopic pretreatment findings revealed that impaired implantation is associated with leiomyoma only where uterine intracavitary abnormalities co-exist. We conclude that implantation rate and pregnancy outcome are impaired in women with uterine leiomyomata only when they cause deformation of the uterine cavity. In patients with leiomyomata associated with an abnormal uterine cavity, surgical treatment should be considered prior to IVF because of the reduced implantation rate. מטאנליזה של כ-6000 מקרים קובעת שגם מיומות אינטרמורליות שאינן מעוותות את החלל השפעה שלילית על תוצאות ה-IVF Hum Reprod. 2010 Feb;25(2):418-29. Epub 2009 Nov 12. The effect of intramural fibroids without uterine cavity involvement on the outcome of IVF treatment: a systematic review and meta-analysis. Sunkara SK, Khairy M, El-Toukhy T, Khalaf Y, Coomarasamy A. Source Assisted Conception Unit, Guy's and St Thomas' Hospitals NHS Foundation Trust, 11th Floor, Tower Wing, Guy's Hospital Great Maze Pond, London SE1 9RT, UK. [email protected] Abstract BACKGROUND: The influence of fibroids on fertility is poorly understood. Submucosal and intramural fibroids that distort the endometrial cavity have been associated with decreased pregnancy rates (PRs) following IVF treatment. However, there is uncertainty about the effect of intramural fibroids that do not distort the endometrial cavity on IVF outcomes. METHODS: We conducted a systematic review and meta-analysis of studies to evaluate the association between non-cavity-distorting intramural fibroids and IVF outcome. Searches were conducted on MEDLINE, EMBASE, Cochrane Library and Web of Science. Study selection and data extraction were conducted independently by two reviewers. The Newcastle-Ottawa Quality Assessment Scales were used for quality assessment. Meta-analysis was performed if appropriate. RESULTS: We identified 19 observational studies comprising 6087 IVF cycles. Meta-analysis of these studies showed a significant decrease in the live birth (RR = 0.79, 95% CI: 0.70-0.88, P < 0.0001) and clinical PRs (RR = 0.85, 95% CI: 0.77-0.94, P = 0.002) in women with non-cavity-distorting intramural fibroids compared with those without fibroids, following IVF treatment. CONCLUSION: The presence of non-cavity-distorting intramural fibroids is associated with adverse pregnancy outcomes in women undergoing IVF treatment. לעומת עבודה זו עבודה פרוספקטיבית שאינה מייחסת חשיבות למיומות אינטרמורליות עד לגודל של 5 ס"מ שאינן מעוותות את החלל בטיפולי ה-IVF Fibroids not encroaching the endometrial cavity and IVF success rate: a prospective study. Somigliana E, De Benedictis S, Vercellini P, Nicolosi AE, Benaglia L, Scarduelli C, Ragni G, Fedele L. Source Department of Obset/Gynecol-Fondazione C&agrave; Granda, Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milano, Italy. Abstract BACKGROUND The impact of fibroids, not encroaching the endometrial cavity, have on the rate of success of IVF is still controversial. Recent meta-analyses suggest a detrimental effect of intramural lesions but not subserosal lesions. However, they also emphasize the need for further evidence. In order to elucidate this, we designed a prospective cohort study to compare the rate of success of IVF in women with and without fibroids. METHODS Exposed women were those with asymptomatic intramural or subserosal fibroids with a diameter below 50 mm and who were selected for IVF. Unexposed women were those free of fibroids, who were matched to cases by age and number of previous IVF cycles. All recruited patients underwent hystero-sonography to rule out intra-cavitary lesions. RESULTS There were 119 cases and 119 controls recruited. The number of clinical pregnancies in women with and without fibroids was 28 (24%) and 22 (19%), respectively (P= 0.43). The adjusted odds ratio (OR) for pregnancy in affected women was 1.38 [95% confidence interval (CI): 0.73-2.60]. The number of deliveries was 22 (18%) and 16 (13%), respectively (P= 0.38). The adjusted OR was 1.45 (95% CI: 0.71-2.94). Similar results emerged when focusing exclusively on women carrying intramural lesions (n= 80 couples). There was no significant relationship between clinical outcome and either the number or size of the fibroids. CONCLUSIONS In asymptomatic patients selected for IVF, small fibroids not encroaching the endometrial cavity did not impact on the rate of success of the procedure. כך שהנושא עדיין קונטרוורסלי ונדרשים עבודות נוספות על מנת לבסס עמדה סופית בשאלת המיומות האינטרמורליות והפעתן על תוצאות ה-IVF