辅助生殖前子宫腺肌病合并不孕的治疗策略

目前已明确辅助生殖技术（assisted reproductive technology，ART）可以改善子宫腺肌病合并不孕患者的妊娠结局，但对于ART前需要采取何种治疗，尚无统一意见。从子宫腺肌病对ART妊娠结局影响的原因入手，重点综述能够改善子宫腺肌病ART结局的治疗措施，包括激素治疗，如促性腺激素释放激素激动剂（gonadotropin releasing hormone agonist，GnRHa）、米非司酮和孕三烯酮等，保守性手术治疗以及一些新手段，如子宫动脉栓塞术和高强度超声聚焦消融（high intensity focused ultrasound，HIFU）等。并针对目前存在的争议，如对药物治疗的具体用法、ART前是否需要腹腔镜手术切除病灶及手术的适应证和局限性、子宫动脉栓塞及HIFU等新手段对妊娠及新生儿有无影响、药物治疗或手术后ART方式及时机的选择等进行阐述。

Treatment Strategy of Adenomyosis Combined with Infertility before Assisted Reproduction

It is clear that assisted reproductive technology（ART） can improve the pregnancy outcome in those patients with adenomyosis and infertility. However, there is not consensus on what kind of treatment to be taken before ART. In this review, we discussed the treatment strategy of adenomyosis as so to improve the pregnancy outcome of ART as follows: hormone treatment，conservative surgery treatment and some new technologies such as uterine artery embolism and high intensity focused ultrasound（HIFU）. The hormone treatment included gonadotropin releasing hormone agonist（GnRHa），mifepristone and gestrinone. And the article described many controversies，such as the detailed drug treatment，the laparoscopic surgery and its indications and limitations before ART, the uterine artery embolism and HIFU and its effects on the pregnancy and newborns，and the type and the timing of ART after drug treatment or surgery.