Management of fibroids prior to in vitro fertilization/ intracytoplasmic sperm injection: A pragmatic approach

Abstract

Fibroids are relatively common in women undergoing in vitro fertilization (IVF) treatment due to their high prevalence in women. It is generally accepted that submucosal fibroids are deleterious to IVF outcomes and their removal is beneficial. Evidence from relatively low quality studies on the impact of intramural fibroids on IVF outcome is also suggestive of a detrimental impact. The majority of published studies included women with relatively small intramural fibroids and women with cavity-distorting fibroids were usually excluded, hence it is quite likely that the detected impact in the systematic reviews is an underestimation. Evidence of benefit is scarce for the removal of noncavity-distorting intramural fibroids. It is quite likely that numbers needed to treat for this purpose would be very high for small fibroids but lower for larger fibroids. This would need to be taken into account when decisions are made on myomectomy and potential benefits should be weighed against the associated morbidity, cost, and delay in fertility treatment. Whilst there is a need to perform prospective randomised studies in this field, a pragmatic approach that takes prognostic factors into account to estimate the magnitude of the possible impact of the fibroid(s) and potential benefit of removal is likely to lead to better reproductive outcomes.

Endometrial preservation during resection of type II and type III submucosal fibroids

“…Submucosal fibroids are known to reduce implantation and clinical pregnancy rates in natural and ART cycles, and their removal improves outcomes ( Pritts et al, 2009 ; Saridogan and Saridogan, 2019 ). Limited data related to Type III fibroids also suggest their presence reduces chance of implantation, clinical pregnancy, and live birth rates in ART cycles ( Yan et al, 2018 ).…”

Management of Fibroids Prior to in Vitro Fertilization. Case Reports

“…Submucosal broids have a detrimental impact on the chances of success with IVF [17] and it is recommended to treat them in sterile patients. Regardless of the treatment applied, the proven restoration of uterine cavity maximizes the chances of a successful IVF [12].…”