Reproductive Outcome of Infertile Patients with Fibroids Based on the Patient and Fibroid Characteristics; Optimal and Personalized Management

Abstract

Aims: To analyze the detailed clinical course of infertile patients with uterine fibroids and to identify optimal and personalized treatment based on the patient or fibroid characteristics. Methods: Retrospective analysis of a case series was performed on 176 infertile patients with fibroids. The patients were classified into different groups according to different treatments (conservative infertility treatment, myomectomy and non-myomectomy surgery). Patient or fibroid characteristics for different groups were analyzed for a possible correlation with the reproductive outcome. Results: The cumulative pregnancy rates by conservative treatment plateaued in 1 year. Myomectomy improved the reproductive outcome in patients who did not conceive with conservative infertility treatments. The most important determinant of the reproductive outcome in patients by conservative treatment prior to surgery was a past patient history of pregnancy. The most important determinant of the reproductive outcome after myomectomy was patient age. Conclusion: Myomectomy should be considered when infertile patients with fibroids do not conceive within 1 year of conservative infertility treatments. The most important determinant of reproductive outcome after myomectomy is patient age. Therefore, for patients younger than 40, the treatment schedule should be carefully considered so that the patients can sufficiently benefit from myomectomy and assisted reproductive technology.

The Effect of Uterine Fibroids on Infertility: A Systematic Review

“…67 Forty-one percent of patients who underwent GnRH agonist followed by myomectomy in one study were able to become pregnant, and they had previously been unable to conceive for an average of 4 years prior to the surgery. 68 Studies have found that myomectomy is beneficial for patients with fibroids who fail conservative infertility treatments, 69 or when fibroids are the only attributable cause of infertility. 70,71 The cumulative rate of pregnancy over a 2-year period in women younger than 30 years who had undergone abdominal myomectomy was 87% in one study, with decreasing probability with increasing age after 30 years.…”

Reproductive Outcomes After Abdominal Myomectomy

“…More over the determinants that had a substantial impact on the out come of the surgery were independent of the treatment (i.e. age, infertility and presence of additional but treatable in fertility factors on the other hand the cumulative pregnancy rate of the population studied is well above that observe in couples with un-explained infertility who are followed up without treatment 6,7 . The study findings were consistent with other studies 8,9 .…”

“…Due to location of fibroids in the uterine cavity it is also associated with recurrent abortions 6 . Myomectomy procedure increase the chances of pregnancy and decreases the rate of spontaneous miscarriage in many studies 6,7 .…”

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“…Sometimes there is improvement in the obstetric situation in women with recurrent miscarriage, or a history of early delivery after conservative myomectomy. Conservative myomectomy improves the obstetric prognosis of subsequent pregnancies [33][34][35]. Considering loss of pregnancy, submucous fibroids are associated with a higher frequency of miscarriages, possibly due to deformation of the uterine cavity, impaired endometrial function, and placentation disorders [36,37].…”