Obstetrics & gynecology science

Korean Society of Obstetrics and Gynecology (대한산부인과학회)
권호 표지

Determinants of Reproductive Outcome after Abdominal Myomectomy in Infertile Women

불임 여성에서 복식 자궁근종절제술 후 임신에 미치는 인자에 관한 연구

Kim, Jae-Duk;Park, Jeong-Kuy;Park, Sun-Hee;Yang, Mi-Ai;Moon, Chang-Sik;Kim, Hyun-Young;Cho, Dong-Hyu;Hwang, Ho-Myong;Jang, In-Suck;Doo, Jae-Kyun
김재덕;박정규;박선희;양미애;문창식;김현영;조동휴;황호명;장인석;두재균

  • Published : 20030300
⟨ Previous Next ⟩

Abstract

Objective: To determine the effect of myomectomy as a treatment for infertility and to define the factors that influence reproductive outcomes Materials and Methods: During the period from January 1995 to December 2001, on 39 patients who suffered from infertility and habitual abortion underwent transabdominal myomectomy at the Department of Obstetrics and Gynecology in Chonbuk National University Hospital. Results: Pregnancy occurred in 31 women. The mean age was 32.3 years. The pregnancy rates in women with or without associated factors in addition to myoma were 55.5% and 71.4%, respectively, and those in women with <2 years versus >2 years of infertility were 73.7% and 55%, respectively. In case of women with myoma on lateral side, pregnancy rate was 33.3%. Considering the size, women with a myoma, 30${\sim}$50 mm in size had higher pregnancy rate (81.2%). The 24-month cumulative probability of conception was 91% in patients <30 years of age, 55.5% in patients 30${\sim}$35years of age, and 40% in patients >35 years of age. Conclusion: Our results suggest a benefit of myomectomy in infertile patients. Factors affecting the pregnancy rate after myomectomy in theses patients are the age of the patient, the duration of infertility, the site of myoma, and the size of myoma <50 mm. However, women should be counseled carefully before surgery because the determinants of outcome appear to be independent of treatment. of patient at high risk for tumor progression who are potential candidate for further aggressive therapy.

목적 : 불임 환자에 대한 치료로써 복식 자궁근종절제술의 효과와 임신성공률에 영향을 주는 요인들에 대해 알아보고자 하였다. 연구방법 : 1995년 1월부터 2001년 12월 사이에 전북대학교 병원 산부인과에서 불임 또는 습관성 유산이 있는 39명의 여성을 대상으로 복식 자궁근종절제술을 시행하였다. 결과 : 대상 환자 39명중 31명에서 임신이 되었으며, 그 평균 연령은 32.3세였다. 자궁근종과 더불어 다른 관련 요인이 있는 경우와 없는 경우의 임신성공률은 각각 55.5%, 71.4%였다. 그리고 불임 기간이 2년 이하인 경우와 2년 이상일 때의 각각의 임신성공률은 73.7%, 55%였다. 자궁의 측면에 근종이 있었던 경우는 임신 성공률이 33.3%였으며, 자궁 근종의 크기가 30${\sim}$50 mm인 경우는 81.2%로 높은 임신성공률을 보였다. 복식 자궁 절제술 후 24개월 이내에 임신된 경우, 나이에 따라 다른 임신성공률을 보였는데, 30세 이하에서는 91.0%, 30${\sim}$35세 사이에서는 55.5%, 35세 이상에서는 40.0%의 임신성공률로써, 나이가 증가할수록 낮은 임신 성공률을 보였다. 결론 : 불임 환자에 있어서 복식 자궁근종절제술을 함으로써 임신성공률을 높일 수 있음을 알게 되었고, 임신성공률에 영향을 줄 수 있는 요인들로는 환자의 나이, 불임 기간, 근종의 크기와 위치 등이 있었다.

Keywords

References

  1. 김태실, 김난경, 조한구, 김관식, 류철희, 김종덕. 불임환자에서 자궁근종절제술 후 임신 성공률. 대한산부회지 제39권 제10호 1996;1892-8
  2. Novak ER, Woodruff ID. Myoma and other benign tumors of the uterus. Gynecologic and Obstetric Pathology, Eighth edition Philadelphia, W. B. Saunders, 1979, vol p260.
  3. Babaknia A, Rock JA, Jones HW Jr. Pregnancy success following abdominal myomectomy for infertility. Fertil Steril 1978; 30: 644-7.
  4. Garcia C-R, Tureck RW. Submucosal leiomyomas and infertility. Fertil Steril 1984; 42: 16-9.
  5. 최영민. 불임여성에 있어 자궁근종절제술 후 임신에 관한 연구. 대한산부회지 제31권 제5호 1988; 692-697.
  6. Paula A. Hillard. Benign disease of the female reproductive tract Novak Gynecology 12th ed., Jonathan S. Berek, p.358-60.
  7. Stevens CS. Myomectomy for improvement of fertility. Fertil Steril 1964; 15: 367-70.
  8. Coutinho EM, Maia HA. The contractile response of the human uterus, fallopian tubes, and ovary to prostaglandines in vivo. Fertil Steril 1971; 22: 539-43.
  9. Hunt JE, Wallach EE. Uterine factors in infertility; an overview. Clinical Obstet Gynecol 1974; 17: 44-64. https://doi.org/10.1097/00003081-197412000-00004
  10. Stevenson CS. Myomectomy for improvement of fertility. Fertil Steril 1964; 315: 367.
  11. Iosif CS, Akerlund M. Fibromyomas and uterine activity. Acta Obstet Gynecol Scand 1983; 62: 165-7. https://doi.org/10.3109/00016348309155784
  12. Farrer-Brown G, Berlby JOW, Rarbit MH. Venous changes in the endometrium of the myomatous uterus. Obstet Gynecol 1971; 38: 743-51.
  13. Buttram VC, Reiter RC. Uterine leiomyomata; etiology, symptomatology and management. Fertil Steril 1981; 36: 433-45.
  14. Berkeley AS, Dechemey AH, Polan ML. Abdominal myomectomy and subsequent fertility. Surg Gynecol Obstet 1983; 156: 319-22.
  15. Donald C, Smith, Jane K, Uhlir. Myomectomy as a reproductive procedure. Am J Obstet Gynecol 1990; 162(6): 1476-82. https://doi.org/10.1016/0002-9378(90)90909-Q
  16. Rosenfeld DL. Abdominal myomectomy for unexplained infertility. Fertil Steril 1986; 42: 328-30.
  17. Eldor-Geva T, Meagher S, Healy DL, MacLachlan V, Breheny S, Wood C. Effect of intramural, subserosal, and submucosal uterine fibroids on the outcome of assisited reproductive technology treatment. Fertil Steril 1998; 70: 687-91. https://doi.org/10.1016/S0015-0282(98)00265-9
  18. Paolo Vercelli, Silvia Maddalena, Olga De Giorgi, Antonella Pesole,et. Determinants of reproductive outcome after abdominal myomectomy for infertility. Fertil Steril 1999; 72: 109-14. https://doi.org/10.1016/S0015-0282(99)00200-9
  19. Sudik R, Husch K, Steller J, DalUlle E. Fertility and pregnancy outcome after myomectomy in sterility patients. Eur J Obstet Gynecol Reprod Biol. 1996 Apr; 65(2): 209-14. https://doi.org/10.1016/0301-2115(95)02363-1
  20. Crosignani PG, Vercellini P, Meschia M, Oldani S, Bramante T. GnRH agonist before surgery for uterine 1eiomyomas; a review. J Reprod Med 1996; 41: 415-21.
  21. Jean-Bernard Dubuisson, Arnold Faucorurier, Charles Chapron, Gustavo Kreiker, Christian Norgaard. Reproductive outcome after 1aparoscopic myomectomy in infertile women. The Journal of Reproductive medicine 2000; 45: 23-30.
  22. T.C Ii, R. Mortimer, I.D. Cooke. Myomectomy: a reproductive study to examine reproductive perfonnance before and after surgery. Human Reproduction 1999; 14: 1735-40. https://doi.org/10.1093/humrep/14.7.1735
  23. A. Rossetti, O. Sissi, L. SoraIma, S. Mancusso, A. Lanzone. Fertility outcome; long-tenn results after laparoscopic myomectomy. Gyncol Endocrinol 2001; 15: 129-34.
  24. Tulandi T, Murray C, Guralnick M. Adhesion fonnation and reproductive outcome after myomectomy and second-look laparoscopy. Obstet Gynecol. 1993 Aug; 82(2): 213-5.