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22A - Intramural Fibroids Greater than 4 cm in Diameter Should Be Removed to Aid Fertility

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from Section III - The Best Policy

Published online by Cambridge University Press:  25 November 2021

Roy Homburg
Affiliation:
Homerton University Hospital, London
Adam H. Balen
Affiliation:
Leeds Centre for Reproductive Medicine
Robert F. Casper
Affiliation:
Mount Sinai Hospital, Toronto
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Summary

Uterine fibroids may cause infertility, depending on their size and their location [1]. The mechanisms linking uterine fibroids and infertility are numerous: uterine cavity distortion according to the FIGO classification; impaired endometrial and myometrial blood supply; increased uterine contractility; hormonal, paracrine and molecular changes; impaired endometrial receptivity and gene expression (decrease in homeobox 10 [HOXA-10] expression); and thicker capsule. The effect on infertility of fibroids distorting the cavity is easy to understand. We will also review the influence of non-cavity-distorting intramural fibroids.

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Publisher: Cambridge University Press
Print publication year: 2021

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References

Donnez, J, Dolmans, MM. Uterine fibroid management: from the present to the future. Hum Reprod Update. 2016;22:665–86.CrossRefGoogle ScholarPubMed
Pritts, EA, Parker, WH, Olive, DL. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril. 2009;91:1215–23.CrossRefGoogle ScholarPubMed
Donnez, J, Dolmans, MM. Hormone therapy for intramural myoma-related infertility from ulipristal acetate to GnRH antagonist: a review. RBMonline. 2020. https://doi.org/10.1016/j.rbmo.2020.05.017 1472-6483/CrossRefGoogle Scholar
Taylor, HS. Fibroids: when should they be removed to improve in vitro fertilization success? Fertil Steril. 2018;109:784–5.CrossRefGoogle ScholarPubMed
Wang, X, Chen, L, Wang, H, Li, Q, Liu, X, Qi, H. The impact of noncavity-distorting intramural fibroids on the efficacy of in vitro fertilization-embryo transfer: an updated meta-analysis. Biomed Res Int. 2018;2018:8924703 Online.Google ScholarPubMed
Rikhraj, K, Tan, J, Taskin, O, Albert, AY, Yong, P, Bedaiwy, MA. The impact of non cavity-distorting intramural fibroids on live birth rate in in vitro fertilization cycles: a systematic review and meta-analysis. J Women’s Health (Larchmt). 2020;29:210–19.CrossRefGoogle Scholar

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