2054例围绝经期及绝经后妇女宫内节育器使用年限及取出情况调查

目的:了解围绝经期及绝经后妇女宫内节育器(IUD)的取出情况及实际使用年限。方法:以在黄浦区居住且末次使用避孕方法为IUD的45~60岁妇女为研究对象,于2011.08~12期间开展横断面调查,共调查2 167人,其中2 054人纳入分析。结果:研究对象平均年龄52.4±4.0岁。1 160例已绝经的妇女中,63例(5.4%)使用的IUD仍未取出,其中15例IUD已放置至绝经后5年以上;IUD的平均宫内放置时间为18.9±5.7年,50.2%的IUD使用者宫内放置时间20年。732例未绝经的妇女中,IUD的平均使用年限为17.3±5.7年,有51.1%的女性使用IUD已超出建议使用期限。结论:绝经后IUD过期使用情况严重,相当一部分正在使用的IUD已超过了使用期限。     

Radiation damage to the uterus -- review of the effects of treatment of childhood cancer

At the present time approximately 1 in 1000 young people aged between 16 and 35 years will have been cured of cancer in childhood and some of the treatment regimens used will have predictable effects on their future fertility prospects. In young women who have been exposed to radiotherapy below the diaphragm, the reproductive problems include the risk of ovarian failure and significantly impaired development of the uterus. The magnitude of the risk is related to the radiation field, total dose and fractionation schedule. Premature labour and low birth weight infants have been reported after flank abdominal radiotherapy. Female long-term survivors treated with total body irradiation and marrow transplantation are also at risk of ovarian follicular depletion and impaired uterine growth and blood flow, and of early pregnancy loss and premature labour if pregnancy is achieved. Despite standard oestrogen replacement, the uterus of these young girls is often reduced to 40% of normal adult size. Uterine volume correlates with the age at which radiation was received. Regrettably, it is likely that radiation damage to the uterine musculature and vasculature adversely affects prospects for pregnancy in these women. It has been demonstrated that, in women treated with total body irradiation, sex steroid replacement in physiological doses significantly increases uterine volume and endometrial thickness, as well as re-establishing uterine blood flow. However, it is not known whether standard regimens of oestrogen replacement therapy are sufficient to facilitate uterine growth in adolescent women treated with total body irradiation in childhood. Even if the uterus is able to respond to exogenous sex steroid stimulation, and appropriate assisted reproductive technologies are available, a successful pregnancy outcome is by no means ensured. The uterine factor remains a concern and women who are survivors of childhood cancer and their carers must recognize that these pregnancies will be at high risk.     

Radiation damage to the uterus — Review of the effects of treatment of childhood cancer

At the present time approximately 1 in 1000 young people aged between 16 and 35 years will have been cured of cancer in childhood and some of the treatment regimens used will have predictable effects on their future fertility prospects. In young women who have been exposed to radiotherapy below the diaphragm, the reproductive problems include the risk of ovarian failure and significantly impaired development of the uterus. The magnitude of the risk is related to the radiation field, total dose and fractionation schedule. Premature labour and low birth weight infants have been reported after flank abdominal radiotherapy. Female long-term survivors treated with total body irradiation and marrow transplantation are also at risk of ovarian follicular depletion and impaired uterine growth and blood flow, and of early pregnancy loss and premature labour if pregnancy is achieved. Despite standard oestrogen replacement, the uterus of these young girls is often reduced to 40% of normal adult size. Uterine volume correlates with the age at which radiation was received. Regrettably, it is likely that radiation damage to the uterine musculature and vasculature adversely affects prospects for pregnancy in these women. It has been demonstrated that, in women treated with total body irradiation, sex steroid replacement in physiological doses significantly increases uterine volume and endometrial thickness, as well as re-establishing uterine blood flow. However, it is not known whether standard regimens of oestrogen replacement therapy are sufficient to facilitate uterine growth in adolescent women treated with total body irradiation in childhood. Even if the uterus is able to respond to exogenous sex steroid stimulation, and appropriate assisted reproductive technologies are available, a successful pregnancy outcome is by no means ensured. The uterine factor remains a concern and women who are survivors of childhood cancer and their carers must recognize that these pregnancies will be at high risk.     

Long-term treatment of leiomyomas with gestrinone

A prospective randomized study was conducted in 100 women with leiomyomas in order to evaluate the effect of gestrinone, a synthetic derivative of ethynil-nor-testosterone. Patients in group A received capsules containing 2.5 mg of gestrinone three times weekly orally. Those in group B received capsules containing 5.0 mg twice weekly, also orally. In group C, patients used by vaginal route tablets containing 5 mg of gestrinone three times weekly. Reduction in uterine volume occurred in all three groups of patients. Of patients who discontinued treatment at 6 months, uterine volume remained lower than pretreatment values in 89%, 18 months after discontinuation. Of those patients who discontinued at 1 year, uterine volume remained below pretreatment levels in 76% 1 year after discontinuation. In patients treated continuously for 24 months, mean uterine volume decreased from a mean 339 cm3 to 273 cm3, a statistically significant difference. The vaginal route showed statistically more significant volume decreases than the oral route for all treatment intervals.     

Rapid reduction of leiomyoma volume during treatment with the GnRH antagonist ganirelix

OBJECTIVE: To assess maximal volume reduction of leiomyomas and uterus and the duration of treatment required to reach these reductions with daily GnRH antagonist treatment. DESIGN: Prospective, open-label study. SETTING: Large teaching hospital in The Netherlands. POPULATION: Premenopausal women with symptomatic fibroids, who were scheduled for surgery. METHODS: Twenty women were treated with daily 2 mg of subcutaneous ganirelix. Prior to the first injection and weekly during treatment, the volume of leiomyomas and the uterus were assessed by ultrasound (USS) and serum hormones were measured. Prior to treatment and when maximal size reduction was observed by USS, the volume of the leiomyomas and the uterus were also assessed by magnetic resonance imaging (MRI). MAIN OUTCOME MEASURES: Leiomyoma and uterine size reduction, time to maximal reduction. RESULTS: One woman was excluded from the study due to incorrect administration dose of ganirelix. Data on the remaining 19 women (average age 39 years) with subserosal (n= 9), submucosal (n= 7), intramural (n= 10) and transmural (n= 1) leiomyomas were evaluated. Baseline leiomyoma volumes ranged from small (3-4 mL) to large (>1000 mL). The median duration of treatment up to maximal leiomyoma size reduction was 19 days (range 1-65 days). The maximal size reduction in leiomyomas measured by USS was -42.7% (-77.0% to 14.1%) and -29.2% (-62.2% to 35.6%) by MRI. Comparable uterine size reductions of -46.6% (-78.6% to -6.1%) and -25.2% (-63.6% to 28.9%) were observed by USS and MRI. During the first three weeks of treatment, 8 out of 19 women reported adverse events related to the induced hypoestrogenic state. Most of these events resolved within one week after treatment was discontinued. CONCLUSION: Daily treatment with 2 mg of ganirelix results in rapid reduction of leiomyoma and uterine volume in premenopausal women with minor side effects. If longer-acting GnRH antagonists become available, pretreatment with GnRH antagonist should be preferred over GnRH agonists prior to surgery.     

腹膜后子宫动脉主干阻断用于大子宫腹腔镜全子宫切除术的临床研究

目的探讨腹膜后子宫动脉主干阻断方法用于大子宫腹腔镜全子宫切除术的安全性及其效果。方法2007年3月至2010年8月在深圳市第九人民医院采用腹膜后子宫动脉主干切断的方法,对子宫大于12孕周、伴宫颈向下牵拉困难的129例患者行腹腔镜全子宫切除术的资料进行回顾性分析。结果129例患者全部经腹腔镜下完成手术,无一例中转开腹,无一例术中输血。其中116例患者（89.9%）先前经过1～3次足月阴道分娩;10例患者经过1～2次剖宫产;3例患者是已婚未产妇;9例患者曾有下腹部手术史。患者年龄36～65岁,平均年龄（45.8±9.5）岁;体重指数平均为（27.3±7.9）;手术时间平均为（152±28）min;子宫重量平均为（438±170）g（360～1120g）;出血量平均（190±85）ml;从切断圆韧带到腹膜后子宫动脉主干阻断的时间平均为（12.8±4.5）min（8～29min）。术后住院时间3～8d,平均为（3.8±2.1）d。术中无输尿管损伤发生。术中发生膀胱损伤3例,经腹腔镜下行修补术,术后7d后治愈,全部患者无术后膀胱和输尿管阴道瘘发生。结论腹膜后子宫动脉主干阻断用于大子宫腹腔镜全子宫切除术是一种安全、有效的术式,为子宫大于12孕周,伴有宫颈向下牵拉困难的患者提供了一种可选择的子宫切除方式。     

A prospective study of outcomes after hysterectomy in mid-aged Australian-born women.

OBJECTIVE: To describe the prevalence of hysterectomy in a mid-aged population-based sample of Australian-born women who were menstruating at baseline and followed for 11 years, and to compare the hysterectomized women with the non-hysterectomized women with regard to symptom reporting and health outcomes. METHODS: This was a 12-year prospective observational study of 438 women who at baseline were aged 45-55 years, not taking hormone therapy (HT) and had menstruated in the previous 3 months. Interviews were conducted face-to-face. RESULTS: After 11 years of follow-up, 39 (9%) women had experienced a hysterectomy, of whom 43.5% had the uterus only removed, 13% had the uterus plus one ovary and 43.5% had the uterus and both ovaries removed. Hysterectomies were performed on average 5.8 years prior to the year 11 interview. The mean age at hysterectomy was 54 years. Multivariate logistic regression analysis, including all co-variates, found that women who had experienced a hysterectomy (+/-oophorectomy) were significantly more likely to complain of trouble sleeping (p < 0.01), have problems with urine control (p < 0.05) and with their bowels (p = 0.07), have used HT (p < 0.05) and have a higher body mass index (p < 0.05). There were no significant associations between hysterectomy and sexuality or hot flush reporting. CONCLUSION: In a community-based sample of Australian-born women, the experience of a hysterectomy after the age of 45 years was associated with bladder, weight and sleeping problems 5-6 years after the surgery.     

Laparoscopic uterine artery ligation for treatment of symptomatic adenomyosis

STUDY OBJECTIVE: To investigate the effect of laparoscopic uterine artery ligation on symptomatic adenomyosis. DESIGN: Prospective pilot study (Canadian Task Force classification II-2). SETTING: Tertiary care major teaching hospital. PATIENTS: Twenty women with symptomatic adenomyosis. INTERVENTION: Laparoscopic ligation of bilateral uterine arteries with hemoclips and electrocoagulation of bilateral uterine ovarian vessels. MEASUREMENTS AND MAIN RESULTS: Patients underwent sonographic measurement of uterine size, and recorded amount of menstruation and dysmenorrhea preoperatively and postoperatively. Six months postoperatively, mean uterine size had decreased by an amount ranging from 0.4% to 74.0%. Two of nine women achieved remission of the mass effect of an enlarged uterus. Thirteen of 16 patients achieved bleeding control and 5 returned to eumenorrhea or hypomenorrhea. Twelve of 16 patients achieved control of dysmenorrhea and 6 were analgesic free. However, nine women experienced nonmenstrual pain after surgery, three of whom underwent hysterectomy later. Treatment was rated as satisfactory by 15% of patients, but 45% were dissatisfied. Seventeen women would have refused to undergo the procedure if they could make the decision again. CONCLUSION: Poor satisfaction in this preliminary study suggests that symptomatic adenomyosis may not be effectively treated by laparoscopic uterine artery ligation.     

Uterine artery embolisation for symptomatic fibroids: the effect of the large uterus on outcome

Objective   The aim of this study was to evaluate the efficacy of uterine artery embolisation (UAE) in myomatous uteri larger than 24 week's gestation (780 cm³).
Design   Prospective case contro study.
Setting   Universitas Hospital, University of the Free State, Bloemfontein, South Africa.
Population   Sixty-one women, who underwent UAE, were included in the study. The study group comprised of 12 women with uteri ≥780 cm³ and the control group 49 women with uteri <780 cm³.
Methods   UAE was performed and the difference in outcome for the two groups was determined at 12 months.
Main outcome measure   Symptomatic improvement with embolisation of the large uterus.
Results   Reduction of dysmenorrhoea, menorrhagia and pressure effects was similar for both groups. The median reduction in uterine volume (pre- to post-embolisation) was 188 cm³ (range 28–2038 cm³) with a 95% CI for the median difference for paired data of 146.5 and 236. Only 66% of the study group had, however, a reduction in volume to <780 cm³. The complication rates were similar for the two groups with regards to post-embolisation syndrome, fibroid slough, haematoma formation, infection, hysterectomy and failure to embolise. Satisfaction was similar between the two groups, with 91% of women satisfied with the procedure.
Conclusion   The large uterus does not decrease UAE's efficacy. Although 33.3% of the study group still had a uterus of ≥780 cm³, symptom reduction was still similar for both groups. Women may thus still be left with a large uterine volume but without symptoms. This must be taken into consideration when counselling women with an extremely large uterus for UAE.     

Embolisation of uterine arteries or laparascopic uterine artery ligation as possible treatment of uterine leiomyoma

Background Many women with symptomatic uterine leiomyomata wish to preserve their uterus. Novel organ- and fertility-preserving treatment options such as embolisation of uterine arteries or laparascopic uterine artery ligation have frequently been discussed as viable alternatives to myomectomy. This article strives to bring together the conclusions of major studies on novel organ-preserving treatment alternatives for uterine myoma.Methods Minimally invasive organ-preserving laparascopic myomectomy remains the best treatment option for patients with symptomatic fibroids who wish to retain their uterus. However, in certain cases other options such as embolisation or laparascopic ligation of uterine arteries can serve as viable alternativesResults A failure rate of up to 39% and complications such as reduced fertility because of ovarian failure after transcatheter embolisation of uterine arteries might restrict the use of this method.Conclusions For postmenopausal women, transcatheter embolisation of uterine arteries is a possible treatment alternative. Laparascopic ligation of uterine arteries and anastomotic sites of uterine arteries with ovarian arteries might also be viable for young women who desire to preserve future fertility. Further data and studies on the long-term follow-up after ligation are yet to come.     

Risk of uterine perforation among users of intrauterine devices

Since 1965 there has been a substantial increase in the number of women in the United States who use the intrauterine contraceptive device (IUD). A collaborative multicenter case--control study was conducted to examine uterine perforation and uterine incarceration as well as several other suspected complications related to use of an IUD. To determine which attributes of the IUD and which user characteristics contribute to the risk of uterine perforation and incarceration, the authors analyzed 32 women with uterine perforation requiring transperitoneal removal, 106 women with uterine incarceration of an IUD which was removed transcervically, and 497 controls. Most important, women who were lactating at the time of IUD insertion were 10 times as likely to have had a uterine perforation as women with at least 1 live birth but who were not lactating at the time of insertion. An incarcerated IUD resulting in a difficult removal was 2.3 times as likely among women lactating at the time of insertion compared to women not lactating at the time of insertion. The likelihood of both uterine perforation and uterine incarceration were unchanged regardless of the type of IUD used.     

Radiotherapy at a young age reduces uterine volume of childhood cancer survivors

BACKGROUND: In contrast to chemotherapy, previous irradiation of the uterus carries an increased risk of an adverse pregnancy outcome. Conflicting results exist as regards the ability of the uterus to increase in volume following radiotherapy-induced damage. We measured uterine volume in a cohort of childhood cancer survivors, and assessed uterine response to a high-dose estrogen replacement regimen. METHODS: Uterine volume was assessed by transvaginal sonography in 100 childhood cancer survivors. Three patients with ovarian failure and severely reduced uterine volume following abdominal or pelvic irradiation were treated with percutaneous estradiol 150 microg/24 h for three cycles, and transvaginal uterine sonography was repeated monthly. RESULTS: Uterine volume was significantly reduced in nulliparous patients who had received direct uterine irradiation (n = 13; median 13 mL, range 1-52 mL) compared with nulliparous patients who had received chemotherapy only (n = 37; 47 mL, 22-88), radiotherapy above the diaphragm (n = 17; 40 mL, 24-61), or radiotherapy below the diaphragm not directly involving the uterus (n = 13; 34 mL, 8-77) (p < 0.02 in all comparisons). Among nulliparous patients a significant correlation was found between age at direct uterine irradiation and uterine volume (r = 0.78, p = 0.002). No significant improvement in uterine volume, endometrial thickness or uterine artery blood flow was observed in three hypogonadal patients in response to high-dose estrogen replacement therapy. CONCLUSIONS: Our results indicate that cytotoxic treatment in childhood does not affect adult uterine size. In contrast, uterine irradiation at a young age reduces adult uterine volume. The radiotherapy-induced damage is probably irreversible.     

Leiomyosarcoma in a series of hysterectomies performed for presumed uterine leiomyomas

The incidence of leiomyosarcoma in uterine leiomyomas is estimated to be between 0.13 to 0.29%. However, the exact incidence of leiomyosarcoma in uteri removed with a preoperative diagnosis of benign uterine leiomyomas has not been previously reported. Between 1983 and 1988, a total of 1432 patients in Women's Hospital, a self-referred indigent population, had a hysterectomy planned because of abnormal uterine bleeding or abdominal pain associated with the presence of uterine leiomyomas, or because of a pelvic mass thought to be uterine leiomyoma of sufficient size or character to warrant surgical exploration. The ages of these women ranged from 36 to 62 years and the presence of leiomyosarcoma in the hysterectomy specimens increased steadily from the fourth to seventh decades of age (0.2%, 0.9%, 1.4%, and 1.7%, respectively). Preoperative histologic examination of the endometrium was performed in eight patients. Three of the eight patients had a preoperative tissue diagnosis of leiomyosarcoma that was clinically confined to the uterus. After the hysterectomy in the 1429 patients with presumed benign disease, histologic diagnosis of leiomyosarcoma was made in seven (0.49%). There was no evidence of malignancy in the endometrial sampling of any of these seven patients and the diagnosis was suspected intraoperatively in only three. Preoperative uterine size ranged from 8 to 20 weeks' gestational size and postoperative uterine weight ranged from 120 to 1100 gm. Seven of the 10 patients had symptoms of abnormal uterine bleeding. Between the ages of 40 and 60 years, 1% (8 of 817) of women with presumed uterine leiomyomas producing symptoms that necessitated hysterectomy in this series had leiomyosarcoma diagnosis postoperatively. Such treatments as gonadotropin-releasing hormone agonists, endometrial ablation, myomectomy by hysteroscopy or laparotomy instead of hysterectomy in such women could delay the diagnosis and definitive treatment of leiomyosarcoma.     

Changes in uterine size after vaginal delivery and cesarean section determined by vaginal sonography in the puerperium

There have been few reports on postpartum changes in the uterus during the three months after delivery. The aim of this study was to evaluate uterine morphological changes in women after vaginal delivery (n=262–351) and in women after cesarean section (n=64–82) and to evaluate the relation between breast-feeding and parity, and uterine involution at 1 and 3 months postpartum measured by vaginal ultrasonography. There were no significant differences in parity between the vaginal delivery group and the cesarean section group. The length of the uterus at one month (7.93±1.16 cm, mean±SD) and, three months (7.03± 1.19 cm) and the width of the uterus at three months (3.83±0.94 cm) after delivery in the cesarean section group were greater than in the transvaginal group (7.64±1.03 cm, 6.65±0.99 cm, 3.57±0.62 cm, respectively). Increasing maternal parity was associated slightly with larger uterine size at one month post partum. The length of the uterus of women with a breast-feeding rate of 80% or more per day was 6.35±0.85 cm, and shorter than in women with a rate of 20% or less 7.03±1.04 cm, at three months after delivery. The width of the uterine body of women with a breast-feeding rate of 80% or more per day was 3.32±0.45 cm, and shorter than in women with a rate of 20% or less 3.87±0.66 cm, at 3 months after delivery. Stepwise regression and multiple regression analysis among parity, the history of cesarean section, the breast-feeding rate at one and three months after the delivery, and the restoration of the menses at three months after the delivery showed that the uterine size at one month after the delivery was related to the cesarean section and that the uterine size at three months after delivery was mostly related to the rate of breast-feeding. These results indicated that uterine involution was related to delivery mode at one and three months postpartum, feeding mode at three months postpartum, the menses restoration, and parity. The rate of breast-feeding was mostly related to the uterine size at three months postpartum. Received: April 1998 / Accepted: 26 March 1999     

Laparoscopic ultrasonic dissection of uterine vessels in women with benign uterine pathologies

Uterine artery dissection is a new minimally invasive surgical technique used for the treatment of leiomyomas and adenomyomas. Three women underwent laparoscopically-assisted bilateral uterine dissection using ultrasonically activated shears. Surgery was uneventful, and patients were discharged on the second day after. Reduction in tumor volume measured by ultrasound was impressive (36%-68%), and the women felt their symptoms had improved. A larger series and longer follow-up are required to evaluate which patients will benefit from this technique. To our knowledge, this is the first report in the literature of origin uterine artery dissection in the area of the off-going part from the hypogastric artery using ultrasonically activated shears in symptomatic leiomyomas.     

Innovative approaches in the treatment of the uterine myoma to restore reproductive function

Abstract

Aim: Uterine myoma (UM) is the most common benign tumor of the uterus and is found in 20–40% of women of reproductive age, thus significantly reducing the reproductive function of women. UM is still treated surgically, and is the most common cause of hysterectomy.

Methods: The study included 234 patients at the age of 29–45 years, who had UM, who have been treated by the drug group of selective progesterone receptor modulators (SPRM) of ulipristala acetate 5?mg for three months. Women were scheduled for surgery.

Results: One hundred and forty-one (60.3%) of women had amenorrhea in 7–9 days. A clear reduction of anemia appeared after the treatment (mild degree – 108 (46.2%) women, 126 (53.8%) of women had a normal level of hemoglobin, p?>?0.05).

The mean value of the uterine size reduction was 30.7% (min – 8%, from 425 to 391?cm³, maximum – 78%, from 1282 to 282?cm³); MM – 27.8% (min 12%, from 285 to 251?cm³, max 55%, from 949 to 427?cm³). In 54 (23.1%) women size of the uterus and fibroids has not changed. Two hundred and sixteen (92.3%) patients were successfully performed laparoscopy, myomectomy. Eighteen (7.7%) patients avoided surgery after treatment, p?>?0.05.

Conclusions: An innovative approach in the use of ulipristala acetate led to a significant regression of the UM, which allowed for the surgical treatment with a minimal impact on the uterus, improving the reproductive prognosis.     

Fertility of females with abnormalities of the uterus

In 209 females examined with hysterosalpingography indications for examination were fertility disturbances in 131 cases, inspection of operation scar after caesarean section in 42 cases, repeated failure of intrauterine device in 9 cases and other causes in 27 cases. Development malformations of the uterus were observed in 54 females (25.8%), which comprised 40 cases with fertility malfunctions and 14 cases who had been delivered of before. The high percentage of women, who, in spite of malformations of the uterus, were delivered either spontaneously or by means of the caesarean section of live children leads to the following conclusions: 1. The occurrence of uterine malformations is more frequent than the incidence in women examined because of fertility malfunctions would indicate. 2. Uterine malformations in women who had been delivered were not always diagnosed. 3. The occurrence of repeated failure of intrauterine device coincides conspicuously with the occurrence of uterine malformations. The diagnosis of developmental malformations of the uterus cannot be always the cause of infertility.     

Functional three-dimensional sonographic study of the postpartum uterus

Objective: To demonstrate sequential changes of the postpartum uterus using two- and three-dimensional (2D and 3D) ultrasounds and Doppler studies.

Methods: Eighty-one women who delivered a singleton at term were recruited for this prospective longitudinal study. Manual and ultrasound examinations of the uterus were performed for seven consecutive weeks. Sequential changes in size of the uterus, endometrial thickness and appearances and Doppler indices of the uterine and arcuate arteries were analyzed.

Results: Complete follow ups were achieved in 71 women who had an uncomplicated postpartum course. 2D and 3D ultrasound estimations of uterine volume are highly correlated with each other (r?>?0.7), but not manual estimations (r?r?r?>?0.7). RI of the arcuate artery was not significantly changed during the study period (r?r?Conclusion: Longitudinal sonographic study showed independent physiologic reversals of uterine volume, endometrium and vascular supply in the first seven weeks following vaginal delivery. Standardization of measurement techniques is essential to apply this information for an early detection of postpartum uterine complications.     

Prehysterectomy embolisation of uterine arteries for large uterine fibroids—a report

Hysterectomy for large uterine fibroids can prove to be a technically difficult procedure. The irregular shape of the uterus filling the pelvis may make access to the pedicles difficult. The larger the size of the uterus, the greater the risk of significant blood loss and trauma to the surrounding structures. Uterine artery embolisation (UAE) has been in use since 1991 as a noninvasive treatment for uterine fibroids and has had encouraging results. Various workers have reported success rates between 86% and 100%. We present here our experience with two patients who underwent embolisation of the uterine arteries, followed by hysterectomy. In both cases, patients had symptomatic uterine fibroids and no desire to conceive. The patients were counselled about the combined treatment and other treatment alternatives available to enable them make an informed choice.     

Assisted reproduction in women with uterine anomalies

A retrospective analysis was performed to evaluate the reproductive performance of 17 women with uterine anomalies who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and embryo transfer (ET). Eight women had a unicornuate uterus, and two a didelphic uterus. Seven women with a subseptate uterus underwent metroplasty before assisted reproduction. Ten (58.8%) out of 17 women achieved 11 (18.0%) pregnancies out of 61 embryo transfers in 55 stimulated cycles. The implantation rate per embryo was 8/83 (9.6%) for women with a unicornuate uterus, one of 17 (5. 9%) for those with didelphic uterus and four of 48 (8.3%) for those with subseptate uterus. Pregnancy rates per embryo transfer were 19. 4, 11.1 and 19.0%, respectively. Three out of 11 pregnancies were ectopic, three were miscarriages and five were full-term deliveries, two sets of twins. Delivery rate per embryo transfer was 5.0% in patients with unicornuate or didephic uterus and 14.3% in women who had a subseptate uterus operated prior to assisted reproduction. Women with uterine anomalies treated by IVF or ICSI had low implantation rates. Pregnancy in a subseptate uterus which has been previously operated had a trend to end more frequently in delivery than that in a unicornuate uterus or in a didelphic uterus.