Submucosal fibroid location and size are predictive factors of impaired fertility. Submucosal fibroids cause infertility through several mechanisms including distortion of the endometrial cavity, increased uterine contractility, local inflammation and remodeling of the endometrial blood supply. This is a monocentric, retrospective, cross-sectional study, conducted in the Department of Obstetrics and Gynecology of 'Sf. Pantelimon' Clinical Emergency Hospital, analyzing patients from a 5-year period (January 2015-December 2019).In the present study, the relationship between different characteristics of the submucosal fibroids (among others, location and dimensions) and fertility (birth rates, early pregnancy loss rates) were investigated. This study identified that submucosal and intramural fibroids are risk factors for reduced birth rate compared with subserosal fibroids (P=0.02, RR=2.58, 95% CI 1.03-6.47; P=0.005, RR=1.18, 95% CI 1.02-1.35, respectively). In addition, G2 leiomyomas are risk factors for low birth rate compared with G0 and G1 fibroids (P=0.01, RR=1.95, 95% CI 1.05-3.60). Moreover, the presence of a subserosal fibroid was associated with an increased early pregnancy loss rate (P=0.01, RR=2.14, 95% CI 1.05-4.35). In conclusion, the location and degree of uterine cavity distortion are important factors that alter the normal development of a pregnancy and the birth rate.

Uterine fibroids are the most common benign tumor that can be found in a woman's reproductivesystem. The uterine fibroid affects millions of women globally each year and we can consider thispathology, without exaggerating, an important public health problem. Our study was carried outprospectively, in 5 years (2015-2019) and enrolled 480 patients selected with uterine fibroid, from anumber of 28809 women who were hospitalized during this period in the university clinic ofObstetrics and Gynecology within the „Saint Pantelimon” Emergency Hospital, Bucharest, Romania.Patients were divided into two groups of study: Group A, those with well-defined, single or multipleuterine fibroid and Group B – patients with diffuse uterine fibromatosis. The clinical,histopathological and immunohistochemical study analyzed and monitored over time, by comparisonbetween the two groups, 52 parameters for each patient, starting with the usual epidemiologicalfactors (age, weight, height, body mass index, personal or family medical history, etc.), continuingwith those related to fertility and other clinical issues (chronic pain, metrorrhagia, number of births,recurrent miscarriage, etc.), up to intraoperative parameters (duration of surgery, blood loss, pelvicdrainage, the need for blood transfusion) and finally, histopathological aspects. We present in thisarticle some of the results of our study, those related to the quality of the endometrium in thefibromatous uterus and the influence that uterine fibroid had on the fertility of our patients.