Paula C Brady1, Aleksandar K Stanic, Aaron K Styer. 1. Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Abstract
PURPOSE OF REVIEW: Uterine fibroids, the most common neoplasm of reproductive-aged women, can have a significant impact on quality of life, and may affect fertility and pregnancy outcomes. Although it is generally accepted that submucosal fibroids are of clinical significance, the effect of intramural and subserosal fibroids, and the benefit of surgical removal remains an area of active debate. Because of this controversy, this article will review current evidence for an association of fibroids and subfertility, and assess the impact of surgical management on fertility outcomes. RECENT FINDINGS: Recent analyses of patients with intramural fibroids have reported an increase in pregnancy loss and reduction in pregnancy and live birth rates. However, when analyzing studies with high quality diagnostic methods for assessing the endometrial cavity, no significant impact on reproductive outcomes was observed, and no benefit of myomectomy was consistently demonstrated. Myomectomy for submucosal fibroids greater than 2 cm and for intramural fibroids distorting the endometrial contour likely confers improvement of fertility outcome. SUMMARY: Submucosal fibroid location and distortion of the endometrial cavity (either submucosal or deeply infiltrating intramural fibroids) are most predictive of impaired fertility and probable benefit of surgical removal, and warrant consideration of myomectomy in the subfertile patient.
PURPOSE OF REVIEW: Uterine fibroids, the most common neoplasm of reproductive-aged women, can have a significant impact on quality of life, and may affect fertility and pregnancy outcomes. Although it is generally accepted that submucosal fibroids are of clinical significance, the effect of intramural and subserosal fibroids, and the benefit of surgical removal remains an area of active debate. Because of this controversy, this article will review current evidence for an association of fibroids and subfertility, and assess the impact of surgical management on fertility outcomes. RECENT FINDINGS: Recent analyses of patients with intramural fibroids have reported an increase in pregnancy loss and reduction in pregnancy and live birth rates. However, when analyzing studies with high quality diagnostic methods for assessing the endometrial cavity, no significant impact on reproductive outcomes was observed, and no benefit of myomectomy was consistently demonstrated. Myomectomy for submucosal fibroids greater than 2 cm and for intramural fibroids distorting the endometrial contour likely confers improvement of fertility outcome. SUMMARY: Submucosal fibroid location and distortion of the endometrial cavity (either submucosal or deeply infiltrating intramural fibroids) are most predictive of impaired fertility and probable benefit of surgical removal, and warrant consideration of myomectomy in the subfertile patient.
Authors: Aaron K Styer; Susan Jin; Dan Liu; Baisong Wang; Alex J Polotsky; Mindy S Christianson; Wendy Vitek; Lawrence Engmann; Karl Hansen; Robert Wild; Richard S Legro; Christos Coutifaris; Ruben Alvero; Randal D Robinson; Peter Casson; Gregory M Christman; Alicia Christy; Michael P Diamond; Esther Eisenberg; Heping Zhang; Nanette Santoro Journal: Fertil Steril Date: 2017-01-12 Impact factor: 7.329
Authors: Lauren A Wise; Laine Thomas; Sophia Anderson; Donna D Baird; Raymond M Anchan; Kathryn L Terry; Erica E Marsh; Ganesa Wegienka; Wanda Kay Nicholson; Kedra Wallace; Robert Bigelow; James Spies; George L Maxwell; Vanessa Jacoby; Evan R Myers; Elizabeth A Stewart Journal: Fertil Steril Date: 2022-02-23 Impact factor: 7.490
Authors: Michael C Pitter; Serene S Srouji; Antonio R Gargiulo; Leslie Kardos; Usha Seshadri-Kreaden; Helen B Hubert; Glenn A Weitzman Journal: Obstet Gynecol Int Date: 2015-04-19