Fibroids and Reproduction

Abstract

Uterine fibroids are commonly seen in women with reproductive disorders such as infertility, spontaneous abortion (SAB), and obstetric complications. Although it is certain that these tumors can occasionally cause such pathophysiology, it is critical to understand the rate of such occurrences, the degree of causality of the fibroids, and our ability to ameliorate the problems via surgical treatment. Evaluation of the available data is hampered by poor quality studies, heterogeneity of the disease, and confounding factors affecting outcomes. Nevertheless, the best available evidence suggests the following: (1) Submucous myomas decrease fertility and increase SAB rates; myomectomy is likely to be of value; (2) intramural myomas may decrease fertility, but the issue is less clear; they do seem to increase rates of miscarriage; there is no solid evidence that myomectomy restores the patient to normal; (3) subserosal myomas do not impair fertility but may enhance the rate of SAB; and (4) fibroids increase the risk of several obstetric complications, including cesarean delivery, malpresentation, postpartum hemorrhage, retained placenta, intrauterine growth retardation, preterm labor, placenta previa, and abruption. Higher quality studies are desperately needed to add confidence to these tenuous conclusions.

Leiomyoma-derived transforming growth factor-β impairs bone morphogenetic protein-2-mediated endometrial receptivity

“…The total economic impact associated with fibroids in the United States (in 2010 dollars) was recently estimated to range between 6 to 34 billion dollars annually (21). Approximately 30 percent of women with leiomyomas are symptomatic, with symptoms including abnormal bleeding, pain, and reproductive dysfunction (impaired implantation, infertility and spontaneous abortion (22, 23). Black women have a 3-fold higher incidence of leiomyomas than white women (24).…”

Counselling Patients with Uterine Fibroids: A Review of the Management and Complications

“…Although myomectomy in early pregnancy has been successfully done, it is not recommended because of the risk of maternal haemorrhage and foetal loss. Other associated problems include placenta praevia and intrauterine growth restriction [14], fetal obstruction with malpresentation or obstructed labour, postpartum haemorrhage, and puerperal infection. Women with fibroids who get pregnant should be allowed to continue pregnancy and all efforts made to make sure they have a normal haemoglobin at delivery.…”

When Should Uterine Fibroids Be Treated?

“…When re-analysis by location is performed, the ten studies examining intramural fibroids and spontaneous abortion rate show a relative risk of 1.604 (95% CI, 1.207-2.131; P00.001). In addition, the three trials examining subserosal fibroids and spontaneous abortion now show a significantly increased risk of 2.190 (95% CI, 1.221-3.930; p00.009) [59].…”