Single intramural leiomyoma with normal hysteroscopic findings does not affect ICSI–embryo transfer outcome

Abstract

Where there is no distortion of the endo-myometrial junction, the effect of an intramural leiomyoma on reproductive performance is controversial. The current study compared the performance of patients having a single leiomyoma and intact endometrium confirmed by hysteroscopy (study group) with that of controls having intact endometrium alone in intracytoplasmic sperm injection (ICSI) cycles. A total of 61 consecutive infertile patients were retrospectively enrolled into the study group from a computerized IVF database. The control group consisted of 444 age-matched patients undergoing ICSI-embryo transfer without any endocervical or intrauterine pathology confirmed by both transvaginal ultrasonography and office hysteroscopy. The baseline characteristics, performance of ovarian stimulation and embryological data were similar between the two groups. The clinical pregnancy per embryo transfer (36 versus 38%) and implantation rate (20 versus 19%) were also comparable. Although the miscarriage rate tended to be higher in the leiomyoma group (27 versus 19%), the difference did not reach statistical significance. In conclusion, in the presence of intact endometrium, a single intramural leiomyoma does not seem to have a deleterious effect on ICSI cycles. Before ICSI is attempted, hysteroscopy may be useful for ruling out distortion of the endometrium due to leiomyoma in selected cases.

The Surgical Treatment of Fibroids for Infertility

“…Six systematic reviews/meta-analyses have been published since 2001. 16,[20][21][22][23][24][25] These reviews greatly assist in collating the available information and help in drawing clinically meaningful conclusions from the heterogeneous data set.…”

“…A recent study by Bozdag and colleagues examined the reproductive performance of women having a single intramural leiomyoma and an intact endometrium (confirmed by hysteroscopy) versus controls, with all patients undergoing in vitro fertilization with intracytoplasmic sperm injection. 25 All had severe male factor infertility. Implantation rates and clinical pregnancy rates were virtually identical for the two groups.…”

Hysteroscopic Surgery for Submucosal Fibroids

“…Similarly, Bozdag et al demonstrated an improvement in spontaneous conception rates after the surgical removal of submucosal fibroids, but pregnancy rates following the removal of intramural or subserosal fibroids were no more improved than in the expectant management group of women with intramural or subserosal fibroids in situ [60]. A recent meta-analysis also demonstrated similar findings, with an improvement in pregnancy rates in infertile patients undergoing surgical removal of submucosal fibroids, but not in those undergoing surgical removal of intramural fibroids [27].…”

Fibroids and Reproduction

“…One, published subsequent to the meta-analysis just cited, is limited to women with intramural myomas. 25 Two early studies chose to investigate women seen in the first trimester for ultrasonographic examination; design shortcomings include inconsistency in time of pregnancy diagnosis and an inherent bias in which patients were referred for ultrasound examination. 51,52 Nevertheless, inclusion of these three studies does not change the overall conclusion: Uterine fibroids increase the rate of SAB.…”