Uterine fibroids and infertility: what evidence do we have regarding cause and treatment?
DOI:
https://doi.org/10.18597/rcog.398Keywords:
fibroids, infertility, myomectomy, laparotomy, hysteroscopy, laparoscopy, pregnancy rateAbstract
Objectives: reviewing the evidence to determine the impact of fibroids on infertility and different types of conservative surgical treatment’s efficacy and safety.
Methodology: the Cochrane Menstrual Disorders and Sub-fertility Review Group specialized register of controlled trials, MEDLINE (PUBMED-MeSH), and OVID (EBM) were searched from 1995 to 2008 for carrying out a qualitative systematic review.
Main results: many observational, retrospective studies have suggested that all infertility-producing myomas are submucosal, intramural myomas bigger than 5 cm thereby altering the endometrial cavity and subserosal myomas whose size distorts reproductive physiology; however, no randomised controlled trials (RCT) were found to support such affirmations. Submucosal myomas must be removed by hysteroscopy (with the exception of myomas bigger than 5 cm or type II); however, no RCTs were found comparing hysteroscopic treatment with other types of treatment. Intramural and subserosal myomas must be removed by laparoscopy or laparotomy (depending on their localisation and size) supported by RCTs showing that there are no outcome differences in terms of reproductive results.
Conclusions: there is limited evidence for suggesting the impact of uterine myomas on infertility and the removal of submucosal myomas by hysteroscopy. Some RCTs show no differences in fertility efficacy outcome if intramural or subserosal myomas are removed via laparotomy or laparoscopy.
Author Biographies
Luis Ernesto Pérez
Ivonne Diaz
Luis Ospina
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