title: Reproductive performance of severely symptomatic women with uterine adenomyoma who wanted preservation of the uterus and underwent combined surgical-medical treatment.
abstract: OBJECTIVE
  To assess the factors associated with future pregnancy and successful delivery in women who were treated for uterine adenomyoma with combination (surgical-medical) therapy using ultramini- or mini-laparotomy conservative surgery and gonadotropin-releasing hormone agonist.
  
  
  METHODS
  One hundred and two women were evaluated. Items for analysis included: age, body mass index, and conception history; clinical symptoms of dysmenorrhea and menorrhagia; tumor location and preoperative serum level of cancer antigen 125 (CA125); the intraoperative findings of the weight of the removed tumor, and the uterine cavity opening.
  
  
  RESULTS
  After excluding those patients using contraception or searching for an assisted reproductive technique, a total of 56 women were enrolled for analysis. Twenty-three (41.1%) women had 27 clinical pregnancies after 3 years of follow-up; 15 went on to deliver a healthy live-born child; two delivered preterm but healthy babies; seven had elective abortions; four had spontaneous abortions; and one had an ectopic pregnancy. The women who had a successful delivery during the 3-year follow-up after treatment tended to be younger, with a lower body mass index, lower baseline analgesic usage score, and lower preoperative serum level of CA125, be nulliparous, and with an adenoma in an anterior location. The linear regression model showed that age and baseline analgesic usage score were independent predictors of successful delivery and accounted for 56.5% of the total variance related to successful delivery.
  
  
  CONCLUSIONS
  Age was an important factor associated with future successful delivery, therefore, caution should be taken in considering the maintenance of future fertility in older women treated with surgical-medical therapy.
authors.affiliation: Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Wen-Hsun
authors.initials: WH
authors.lastname: Chang
authors.forename: Kuan-Chin
authors.initials: KC
authors.lastname: Wang
authors.forename: Na-Rong
authors.initials: NR
authors.lastname: Lee
authors.forename: Nicole
authors.initials: N
authors.lastname: Huang
authors.forename: Wen-Hsiang
authors.initials: WH
authors.lastname: Su
authors.forename: Hsiang-Tai
authors.initials: HT
authors.lastname: Chao
authors.forename: Ming-Shyen
authors.initials: MS
authors.lastname: Yen
authors.forename: Jong-Ling
authors.initials: JL
authors.lastname: Fuh
authors.forename: Peng-Hui
authors.initials: PH
authors.lastname: Wang
mesh_terms: D018194:Adenomyoma / Q000150:complications / Q000628:therapy*; D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004412:Dysmenorrhea / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000517:prevention & control*; D007813:Laparotomy; D016729:Leuprolide / Q000627:therapeutic use*; D016014:Linear Models; D008595:Menorrhagia / Q000209:etiology; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011247:Pregnancy; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000150:complications / Q000628:therapy*; D014599:Uterus / Q000601:surgery*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D016729:Leuprolide