The impact of uterine fibroids on reproductive function


Authors: R. Krajčovičová;  R. Hudeček
Authors‘ workplace: Gynekologicko-porodnická klinika LF MU a FN Brno
Published in: Prakt Gyn 2010; 14(4): 154-163
Category: Review

Overview

The paper provides a comprehensive overview of uterine fibroids in the context of female sterility and infertility. A uterine fibroid (myoma, leiomyoma) is the most frequent benign tumour of the uterine body, affecting 30–50% of women aged 30–50 years [1]. In view of the increasing incidence of uterine fibroids among women planning conception, myomas and reproduction disorders are a topical issue. Careful evaluation of a clinical picture and detailed diagnostics of the number, localization and type of myomas should be followed by a consideration on whether or not uterine fibroids in a specific patient are the causal factor of sterility or infertility, to what extend and what therapeutic options are available. Global studies available so far suggest that a myoma exceeding 5 cm and/or situated near the cervix or the utero-tubal junction appears to be a causing factor of sterility [11]. The actual impact on fertility is derived from the close association between uterine myoma and uterine cavity. The only statistically significant impact on the number of clinical pregnancies and live births was shown in association with submucous and intramural fibroids [12]. The traditionally accepted causal relationship between fibroids and abortions is being disputed by some studies, particularly in patients with a solitary myoma. Rather than the size or localization of the leiomyoma, the future of the pregnancy depends on the position of implantation in relation to the myoma [7]. A number of recent studies have confirmed significantly poorer results of assisted reproduction cycles (implantation rate, pregnancy rate, delivery rate) and significant reduction in the success of IVF cycles in women with leiomyoma compared to control groups (most frequently compared to women whose sterility is associated with fallopian tubes), including intramural fibroids not distorting the uterine cavity [4–6]. Laparoscopic or laparotomic myomectomy are the predominant treatment approaches for intramural and subserous myomas. This intervention is recommended in infertile women with diagnosed leiomyoma exceeding 4 cm. Myomectomy is appropriate in very large myomas (above 7 cm) and symptomatic myomas (menometrorrhagia) in women with multifactorial cause of infertility [7]. Hysteroscopic myomectomy is recommended in submucous myomas exceeding 3 cm and distorting the uterine cavity. Literature suggests that this method provides significant increase in live birth rate [34]. We discuss the correlation between performed myomectomy and an outcome of assisted reproduction. Many global studies confirm usefulness of myectomy performed prior to in vitro fertilization cycle [4,6,17,31,35]. Considering the complex relationship between uterine myomatosis and female reproduction, every specific patient case requires individual evaluation, careful assessment of reproductive history, exclusion of other factors of sterility and detailed diagnosis of the localization, number and size of myomas. Only then it will be possible to select an appropriate individualized therapeutic approach for a specific patient.

Key words:
uterine myomatosis – metrorrhagia – habitual abortion – GnRH analogues – myomectomy – heteroscopy – uterine artery embolization – hysterectomy


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Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine
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