Fibroids not encroaching the endometrial cavity and IVF success rate: a prospective study

Abstract

BACKGROUND The impact of fibroids, not encroaching the endometrial cavity, have on the rate of success of IVF is still controversial. Recent meta-analyses suggest a detrimental effect of intramural lesions but not subserosal lesions. However, they also emphasize the need for further evidence. In order to elucidate this, we designed a prospective cohort study to compare the rate of success of IVF in women with and without fibroids. METHODS Exposed women were those with asymptomatic intramural or subserosal fibroids with a diameter below 50 mm and who were selected for IVF. Unexposed women were those free of fibroids, who were matched to cases by age and number of previous IVF cycles. All recruited patients underwent hystero-sonography to rule out intra-cavitary lesions. RESULTS There were 119 cases and 119 controls recruited. The number of clinical pregnancies in women with and without fibroids was 28 (24%) and 22 (19%), respectively (P= 0.43). The adjusted odds ratio (OR) for pregnancy in affected women was 1.38 [95% confidence interval (CI): 0.73-2.60]. The number of deliveries was 22 (18%) and 16 (13%), respectively (P= 0.38). The adjusted OR was 1.45 (95% CI: 0.71-2.94). Similar results emerged when focusing exclusively on women carrying intramural lesions (n= 80 couples). There was no significant relationship between clinical outcome and either the number or size of the fibroids. CONCLUSIONS In asymptomatic patients selected for IVF, small fibroids not encroaching the endometrial cavity did not impact on the rate of success of the procedure.

The rapid growth of fibroids during early pregnancy

“…We stated as clinically relevant a relative increase in diameter of 30%. Based on an expected mean 6 SD diameter of the fibroids in our population of 22610 mm [10], the total number of patients to be enrolled was of about 50 women (25 cases and 25 controls).…”

Platelet Serotonin Concentration and Monoamine Oxidase Activity in Hypothyroid Patients

“…Hormones of the hypothalamic-pituitary-thyroid (HPT) axis, triiodothyronine (T 3 ), thyroxine (T 4 ), and thyroid-stimulating hormone (TSH), play an important role in the development of the central nervous system [1], and regulate the metabolism and function of various neurotransmitters [2,3,4], their receptors, second-messengers [5], and gene expression [6]. Evidence for the interaction between serotonin (5-hydroxytryptamine, 5-HT) and thyroid hormones originates mostly from the experimentally induced hypothyroid state in animals [3].…”

“…Evidence for the interaction between serotonin (5-hydroxytryptamine, 5-HT) and thyroid hormones originates mostly from the experimentally induced hypothyroid state in animals [3]. Decreased 5-HT [7, 8] and increased 5-hydroxyinoleacetic acid [9] concentrations were observed in neonatal and adult hypothyroid rats, suggesting an increased 5-HT turnover [7, 10], while T 3 administration to hypothyroid animals normalized 5-HT turnover to normal values [10].…”

Should we operate on fibroids before IVF?

“…They concluded that "future efforts should be aimed to identify the subgroup of women" in whom the fibroid can increase risk. However, like others, they do not advise as to how the authors should identify these patients other than by size and location [23].…”

“…Somigliana et al concluded in a recent prospective study that in asymptomatic patients with intramural fibroids smaller than 5 cm not invading the cavity, the results were not affected [23]. They concluded that "future efforts should be aimed to identify the subgroup of women" in whom the fibroid can increase risk.…”