Who will benefit from uterus sparing surgery in adenomyosis associated subfertility

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

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.

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