摘要Background:The relationship between intramural myomas and fertility remains unclear.The main debate rests on whether cavity-distorting intramural lnyomas (CDMs) adversely affect fertility more than non-CDMs.We aimed to compare the effects ofenucleating non-CDMs and CDMs on fertility improvement in females with unexplained infertility.Methods:We prospectively recruited 83 women undergoing myomectomy for unexplained infertility with intramural myomas between June 2008 and November 2012 and classified them into non-CDMs group (n =45) and CDMs group (n =38).We then compared postoperative infertility rates,spontaneous pregnancy rates,pregnancy outcomes,live birth rates,and obstetric complications.For continuous variables,we calculated the mean ± standard deviation,median and interquartile range,and analyzed the data using Student's t-test and the Mann-Whitney U-test.For categorical variables,the Pearson's Chi-square test,the continuity correction test,and Fisher's exact test were used.Results:Patients' demographics and myoma characteristics were comparable between the two groups.The overall spontaneous pregnancy rate increased from 0％ to 68.42％ following myomectomy.The postoperative infertility rate was significantly higher in the non-CDMs group than that in the CDMs group (50.00％ vs.23.53％,t =5.579,P =0.018),whereas the postoperative spontaneous pregnancy rate was significantly lower in the non-CDMs group than that in the CDMs group (47.62％ vs.70.59％,t 4.067,P =0.044).Compared with the enucleation ofnon-CDM,the enucleation of CDM patients was a protective factor for the fertility restoration (risk ratio [RR] =3.717,95％ confidence interval [CI]:1.284-10.753,P =0.015),although postoperative fertility restoration declined with age (RR =1.141,95％ CI:1.005-1.295,P =0.041).Conclusions:Intramural myomas are associated with impaired fertility.Women experiencing unexplained infertility,and possessing intramural myomas,have a better chance of conception following myomectomy,and these benefits are more obvious for younger patients and patients with CDM.