Effect of type 3 intramural fibroids on in vitro fertilization–intracytoplasmic sperm injection outcomes: a retrospective cohort study

Yan, Lei; Yu, Qi; Zhang, Yanan; Guo, Zizhen; Li, Zhongyuan; Niu, Jinlei; Ma, Jinlong

doi:10.1016/j.fertnstert.2018.01.007

Cited by 52 publications

(55 citation statements)

References 18 publications

(25 reference statements)

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“…Given the evidence that contact with the endometrium is associated with impaired decidualization, it could be hypothesized that ''intramural'' myomas that are in contact with the endometrium may have a very different impact on implantation than those with myometrium between the myoma and the endometrium. For example, a recent study that used the FIGO classification system demonstrated that single or multiple type 3 leiomyomas, R2 cm in diameter, individually or collectively, were associated with a lower implantation rate as well as a reduced rate of clinical pregnancy and delivery (129). Biochemical pregnancy (29.1% vs. 51.4%), implantation (22.7% vs. 34.4%), clinical pregnancy (27.8% vs. 43.9%), and live birth rates (21.2% vs. 34.4%) were significantly reduced in the women with type 3 myomas compared with controls.…”

Section: Leiomyomasmentioning

confidence: 99%

Uterine polyps, adenomyosis, leiomyomas, and endometrial receptivity

Munro

2019

Fertility and Sterility

153

103

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Endometrial polyps, adenomyosis, and leiomyomas are commonly encountered abnormalities frequently found in both fertile women and those with infertility. The clinician is frequently challenged to determine which of these entities, when found, is likely to impair fertility, and which are ''innocent bystanders'' unrelated to the problem at hand. Although removing an endometrial polyp may be seen as a relatively benign and safe intervention, myomectomy, and in particular adenomyomectomy, can be substantive surgical procedures, associated with their own potential for disrupting fertility. One of the mechanisms thought to be involved when these entities are contributing to infertility is an adverse impact on endometrial receptivity. Indeed polyps, adenomyosis, and leiomyomas have all been associated with an increased likelihood of abnormal endometrial molecular expressions thought to impair implantation and early embryo development. This review is designed to examine the relationship of these common entities to endometrial receptivity and to identify evidence gaps that should be considered when strategizing research initiatives. It is apparent that we have the tools necessary to fill these gaps, but it will be necessary to approach the issue in a strategic and coordinated fashion. It is likely that we will have to recognize the limitations of imaging alone and look to the evidence-based addition of molecular analysis to provide the individualized phenotyping of disease necessary for patient-specific treatment decisions. (Fertil Steril Ò 2019;111:629-40. Ó2019 by American Society for Reproductive Medicine.

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Section: Leiomyomasmentioning

confidence: 99%

Uterine polyps, adenomyosis, leiomyomas, and endometrial receptivity

Munro

2019

Fertility and Sterility

153

103

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“…Any role of nonindenting fibroids in infertility remains to be determined, with some researchers finding no impact on fertility and others indicating a negative effect. [16][17][18][19][20][21][22][23] With regard specifically to pregnancy after ART, there have been several reports (including a metaanalysis) that showed a deleterious impact of fibroids upon assisted reproduction, including ICSI. 20,21,23 Thus, while speculative, it is possible that the resolution of the intramural fibroid after treatment with the Sonata System might have played a role in enabling successful ET postablation.…”

Section: Discussionmentioning

confidence: 99%

Term Delivery in an Infertile Patient after Transcervical Radiofrequency Fibroid Ablation and Assisted Reproductive Technology

Pschadka¹,

Engelhardt²,

Niehoff³

et al. 2019

Journal of Gynecologic Surgery

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Background: Transcervical radiofrequency (RF) ablation of uterine fibroids is an incisionless procedure to treat nonpedunculated uterine fibroids, including those that are not amenable to operative hysteroscopy. However, its safety and effectiveness regarding fertility and fecundity have not been established, including among women with infertility. Case: A 38-year-old nullipara with infertility since 2008 and a recent complaint of refractory dysmenorrhea in association with a uterine fibroid underwent transcervical RF ablation with the Sonata Ò System (Gynesonics, Redwood City, CA) to treat the symptomatic myoma. Unsuccessful assisted reproduction (intracytoplasmic sperm injection/embryo transfer) as confirmed by negative pregnancy testing had been attempted 1 month preablation, and a second embryo transfer after thawing the previously cryopreserved pronuclei was performed 7 months postablation. Results: RF ablation with the Sonata System resulted in a 68% reduction in fibroid volume noted on sonography 2 months post-treatment along with resolution of the patient's dysmenorrhea. No residual fibroid was noted on sonography 7 months postablation. A second attempt at assisted reproduction produced an uncomplicated pregnancy that resulted in vacuum-assisted vaginal delivery of a liveborn infant at term weighing 3670 g with Apgar scores of 9 1 /10 5 /10 10. Pelvic sonography 4 months postpartum an unremarkable uterus, again, with no evidence of a fibroid remnant. Conclusions: This is the first report of a pregnancy and delivery in an infertile couple who underwent transcervical RF ablation of a uterine fibroid followed by assisted reproduction.

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“…Two factors were significant, namely the size of myomas and the proximity of the uterine cavity [ 12 ]. As reported by Yan et al [ 42 ], a type 3 myoma measuring 2 cm or more situated close to the endometrial lining will have a detrimental effect. As stressed very recently by Freytag et al [ 11 ], although intramural myomas are reported to be associated with poorer pregnancy outcomes than in women without myomas, studies addressing the question of improved conception capacity after myomectomy are few and far between.…”

Section: Non-cavity-distorting Uterine Fibroids and Infertility: Conclusive Remarks From Recent Literature Reports And Meta-analysesmentioning

confidence: 91%

Conservative Management of Uterine Fibroid-Related Heavy Menstrual Bleeding and Infertility: Time for a Deeper Mechanistic Understanding and an Individualized Approach

Dolmans

Cacciottola

Donnez

2021

JCM

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(1) Background: Uterine fibroids are the most common form of benign uterine tumors, causing heavy menstrual bleeding (HMB), pelvic pain, infertility and pressure symptoms. Almost a third of women with uterine fibroids seek treatment. The objective of this review is to understand the mechanisms linking fibroids to these symptoms and evaluate different options for their management, particularly the place of gonadotropin-releasing hormone (GnRH) antagonist. (2) Methods: We gathered the most recent and relevant papers on the main fibroid-related symptoms and medical and surgical therapy for their treatment. Those reporting use of oral GnRH antagonists were investigated in detail. (3) Results: The mechanisms explaining myoma-related HMB and infertility were reviewed, as they are essential to a deeper mechanistic understanding and oriented approach. The choice of treatment depends on the number, size, and location of fibroids, and is guided by the patient’s age and desire to preserve her fertility. Economic impacts of myomas in terms of direct costs, lost workdays, and complications were found to be significant. Medical, surgical, and non-surgical strategies were analyzed in this context. Novel medical approaches with GnRH antagonist were explored and found to represent an effective new option. (4) Conclusion: The need for alternatives to surgical intervention is very real, especially for women seeking to preserve their fertility. New options now exist, with GnRH antagonists proven to treat fibroid symptoms effectively, opening the door to novel strategies for the management of myomas.

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Effect of type 3 intramural fibroids on in vitro fertilization–intracytoplasmic sperm injection outcomes: a retrospective cohort study

Cited by 52 publications

References 18 publications

Uterine polyps, adenomyosis, leiomyomas, and endometrial receptivity

Uterine polyps, adenomyosis, leiomyomas, and endometrial receptivity

Term Delivery in an Infertile Patient after Transcervical Radiofrequency Fibroid Ablation and Assisted Reproductive Technology

Conservative Management of Uterine Fibroid-Related Heavy Menstrual Bleeding and Infertility: Time for a Deeper Mechanistic Understanding and an Individualized Approach

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