Intramural myomas more than 3–4 centimeters should be surgically removed before in vitro fertilization

Dolmans, Marie-Madeleine; Isaacson, Keith; Zhang, Wenjia; Gordts, Stephan; Munro, Malcolm G.; Stewart, Elizabeth A.; Santulli, Piétro; Donnez, Jacques

doi:10.1016/j.fertnstert.2021.08.016

Cited by 27 publications

(24 citation statements)

References 153 publications

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“…Open or laparoscopic myomectomy changed the fertility of infertile patients, however they had a high incidence of postoperative pelvic adhesions that can lead to pain and infertility, blood loss and a longer operating room time [ 6 ]. At the same time open surgery is invasive and the incision may be painful after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In severe cases the wound may not heal properly. Laparoscopic removal of intramural fibroids results in uterine scarring which may affect subsequent pregnancies [ 6 ]. In contrast operative hysteroscopy is the optimal treatment for normalizing the uterine cavity in patients with lesions associated with infertility [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopic removal of intramural fibroids results in uterine scarring which may affect subsequent pregnancies [ 6 ]. In contrast operative hysteroscopy is the optimal treatment for normalizing the uterine cavity in patients with lesions associated with infertility [ 6 ]. When a type 3 myoma is removed hysteroscopically using a bipolar loop electrode the surgery is contained within the pseudocapsule and no normal myometrium is damaged.…”

Section: Discussionmentioning

confidence: 99%

“…When a type 3 myoma is removed hysteroscopically using a bipolar loop electrode the surgery is contained within the pseudocapsule and no normal myometrium is damaged. Because there are no abdominal incisions with the hysteroscopic approach, the patient can return to normal activities in 24 h [ 6 ]. Unfortunately, it can also lead to complications such as the formation of intrauterine adhesions postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…The location of the fibroids, size, and number influence the woman's fertility and the outcome of pregnancy in unascertained ways [3]. The mechanisms linking uterine fibroids and infertility are numerous: uterine cavity distortion, impaired endometrial and myometrial blood supply, increased uterine peristalsis during mid luteal phase, molecular changes, impaired endometrial receptivity and a thicker capsule [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Hysteroscopic resection of type 3 fibroids could improve the pregnancy outcomes in infertile women: a case–control study

Han

Yao

Zhang

et al. 2022

BMC Pregnancy Childbirth

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Background Type 3 fibroids are a special subtype of intramural fibroids that are likely to affect the pregnancy outcomes of assisted reproductive techniques. Hysteroscopic resection is a treatment for type 3 fibroids, but there has few study of its efficacy to date. In this study we evaluated the effect of hysteroscopic resection of type 3 fibroids on the pregnancy outcomes in infertile women. Methods This retrospective case–control study was conducted from January 1, 2014 to June 30, 2021. Patients who underwent IVF-ICSI in our unit were divided into a type 3 fibroid group and a hysteroscopic myomectomy group. The inclusion criteria for the type 3 fibroid group and the hysteroscopic myomectomy group were as follows: 1) age ≤ 40 years; 2) fibroid diameter or total fibroid diameter > 2.0 cm. The following exclusion criteria were used: 1) oocyte donor treatment cycles and 2) presence of chromosomal abnormalities; 3) history of other uterine surgery; 4) presence of intracavitary lesions, including submucosal fibroids; 5) single fibroid > 5.0 cm; 6) cervical fibroids; 7) unclear ultrasound description of fibroids; 8) preimplantation genetic testing was performed and 9) congenital or acquired uterine malformations. The control group in our study was selected from patients who were treated with IVF only because of fallopian tube factors. According to the age of the type 3 fibroid group and hysteroscopic myomectomy group, random sampling was carried out in the patients between 25 and 47 years of age to determine a control group. The outcomes measured included the average transfer times to live birth, cumulative clinical pregnancy rate, and cumulative live birth rate. Results A total of 302 cycles were enrolled in our study, including 125 cycles with type 3 fibroids, 122 cycles with hysteroscopic myomectomy, and 139 cycles of control patients. The average transfer times to live birth were significantly higher in the type 3 fibroid group than in the other two groups. The frequency of cumulative live births in the type 3 fibroid group was significantly lower than that in the control group. Compared with the control group, the hysteroscopic myomectomy patients had no statistically significant differences in the cumulative clinical pregnancy rate and cumulative live birth rate. Conclusions Type 3 fibroids significantly reduced the cumulative live birth rate of IVF patients. Ultrasound-guided hysteroscopic myomectomy can be used as a treatment for type 3 fibroids and could improve the pregnancy outcomes in infertile women.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Hysteroscopic resection of type 3 fibroids could improve the pregnancy outcomes in infertile women: a case–control study

Han

Yao

Zhang

et al. 2022

BMC Pregnancy Childbirth

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Impact of FIGO type 3 uterine fibroids on in vitro fertilization outcomes: A systematic review and meta‐analysis

Favilli

Etrusco

Chiàntera

et al. 2023

Intl J Gynecology & Obste

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BackgroundThe effect of FIGO (the International Federation of Gynecology & Obstetrics) type 3 myomas on in vitro fertilization (IVF) is uncertain.ObjectivesTo evaluate whether FIGO type 3 myomas affect IVF outcomes, through a systematic review and meta‐analysis (CRD42022379700).Search strategyElectronic databases were searched until November 15, 2022.Selection criteriaStudies evaluating the effects of FIGO type 3 myomas on IVF outcome.Data collection and analysisPooled results were expressed as odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was assessed using Higgins I2. Sources of heterogeneity were explored with sensitivity and subgroup analyses.Main resultsIn total, 1020 patients were included: 324 with FIGO type 3 myomas and 696 controls (without myomas). A pooled data analysis showed a significantly lower live birth rate (OR 2.16, 95% CI 1.55–3.01, I2 = 0%, P < 0.00001), clinical pregnancy rate (OR 2.06, 95% CI 1.52–2.81, I2 = 0%, P < 0.00001), and implantation rate (OR 1.77, 95% CI 1.35–2.32, I2 = 0%, P < 0.00001) in women with untreated myomas compared with controls. The number and size of fibroids correlated with a worsening of IVF outcomes.ConclusionsFIGO type 3 myomas are significantly associated with a lower implantation rate, cumulative pregnancy rate, and live birth rate. Furthermore, their deleterious effect on the outcome of IVF increases further with increasing size and number. Nevertheless, no firm conclusions could be drawn about the potential benefits of surgery for FIGO type 3 uterine fibroids on IVF outcomes.

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The challenge of FIGO type 3 leiomyomas and infertility: Exploring therapeutic alternatives amidst limited scientific certainties

Favilli,

Mazzon,

Etrusco

et al. 2023

Intl J Gynecology & Obste

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Uterine leiomyomas (ULs) are non‐cancerous tumors composed of smooth muscle cells that develop within the myometrium and represent the most prevalent pathological condition affecting the female genital tract. Despite the volume of available research, many aspects of ULs remain unresolved, making it a “paradoxical disease” where the increase in available scientific literature has not been matched by an increase in solid evidence for clinical management. Fertility stands at the top of the list of clinical issues where the role of ULs is still unclear. The leiomyoma subclassification system, released by the International Federaion of Gynecology and Obstetrics (FIGO) in 2008, introduced a new and more effective way of categorizing uterine fibroids. The aim was to go beyond the traditional classification “subserosal, intramural and submucosal”, facilitating a detailed examination of individual ULs impact on the female reproductive system. The “type 3 UL” is a special type of myoma, characterized by its complete myometrial development while encroaching the endometrium. It is a unique “hybrid” between a submucous and an intramural UL, that may exert a detrimental “double hit” mechanism, which is of particular interest in patients wishing pregnancy. To date, no robust evidence is available regarding the management of type 3 ULs. The aim of this narrative review is to provide a comprehensive overview of the physiopathological mechanisms that type 3 UL may exert on fertility, and to present new perspectives that may help us to better understand both the need for and the methods of treating this unique type of fibroid.

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Intramural myomas more than 3–4 centimeters should be surgically removed before in vitro fertilization

Cited by 27 publications

References 153 publications

Hysteroscopic resection of type 3 fibroids could improve the pregnancy outcomes in infertile women: a case–control study

Hysteroscopic resection of type 3 fibroids could improve the pregnancy outcomes in infertile women: a case–control study

Impact of FIGO type 3 uterine fibroids on in vitro fertilization outcomes: A systematic review and meta‐analysis

The challenge of FIGO type 3 leiomyomas and infertility: Exploring therapeutic alternatives amidst limited scientific certainties

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