臨床婦人科産科76巻4号

2022年04月発行

増刊号 最新の不妊診療がわかる！―生殖補助医療を中心とした新たな治療体系 第1章　生殖補助医療の適応と意義―どんな患者さんが体外受精・顕微授精を受けるのか

子宮筋腫・内膜症と体外受精―その不妊機序と一般不妊治療・体外受精の有効性

著者： 小野政徳¹ 山田悦子¹ 河村ともみ¹ 久慈直昭¹ 西洋孝¹

所属機関： ¹東京医科大学産科婦人科学分野

ページ範囲：P.18 - P.22

▶子宮筋腫と子宮内膜症は生殖年齢女性に高頻度に認められる疾患で，妊娠に対する負の影響が大きな問題となる．
▶粘膜下子宮筋腫は，妊娠率を低下させる．また，腫瘍径4cmを超える筋層内筋腫も妊娠率を低下させる可能性がある．一方で，漿膜下子宮筋腫の多くは妊娠に影響を与えない．
▶子宮内膜症に対する適切な腹腔鏡手術で自然妊娠率が改善される可能性がある．
▶子宮内膜症合併不妊でARTを要する場合には原則としてARTを先行させる．
▶有症状の子宮内膜症でARTを要する場合には採卵・胚凍結保存後の腹腔鏡手術が検討される．
▶悪性化した可能性のある子宮内膜症では手術を先行する．

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