Removal of myomas in asymptomatic patients to improve fertility and/or reduce miscarriage rate: a guideline

Abstract

The purpose of this systematic review is to evaluate if uterine myomas impact the likelihood of pregnancy and pregnancy loss, and if myomectomy influences pregnancy outcomes in asymptomatic women. There is insufficient evidence to conclude that the presence of myomas reduces the likelihood of achieving pregnancy. However, there is fair evidence that myomectomy (open or laparoscopic) for cavity-distorting myomas (intramural or intramural with a submucosal component) improves pregnancy rates and reduces the risk of early pregnancy loss. There is fair evidence that hysteroscopic myomectomy for cavity-distorting myomas improves clinical pregnancy rates but insufficient evidence regarding the impact of this procedure on the likelihood of live birth or early pregnancy loss. In women with asymptomatic cavity-distorting myomas, myomectomy may be considered to optimize pregnancy outcomes.

Nationwide population-based cohort study of adverse obstetric outcomes in pregnancies with myoma or following myomectomy: Retrospective cohort study

“…Previously, ACOG stated that myomectomy should be considered for a woman with uterine leiomyomas who has undergone several unsuccessful IVF cycles despite appropriate ovarian response and goodquality embryos. 24 SOGC, ASRM, and French guidelines also stated that intramural myomas may have a negative effect on fertility, but treating them does not improve fertility, and myomectomy is therefore indicated only for symptomatic myomas, 6,24,25 They emphasized that information should be provided about the risk of uterine rupture during a future pregnancy, before planning a myomectomy in women who might become pregnant later on.…”

“…Because there is insu cient evidence that myomectomy improves pregnancy outcomes, a practice committee of the American Society for Reproductive Medicine (ASRM) and the Society of Obstetricians and Gynaecologists of Canada (SOGC) are against myomectomy in asymptomatic women with non-cavity-distorting myomas. 6,7 However, in US Census Bureau population projections, it was estimated that myomectomies are predicted to increase 31% between 2007 and 2050. 8 In Korea, the number of women who underwent myomectomy have increased 37.3% between 2006 and 2010.…”

Recurrent Pregnancy Loss: Investigations and Interventions

“…Hysteroscopy is considered the gold standard for the diagnosis of submucosal fibroids, but this pathology can be identified through other imaging exams, such as ultrasound mapping [2]. The evaluation of the uterine cavity is strongly recommended for all women with RPL, since the removal of submucosal fibroids in infertile patients seems to reduce the chance of miscarriage [2,49]. Regarding fibroids that do not distort the uterine cavity, there is no evidence indicating that myomectomy may reduce the chances of an abortion [2,49].…”

“…Although there is no evidence of the benefit of polypectomy in women with RPL, hysteroscopic removal should be considered when the polyp is larger than 1 cm when no other known etiology is found [2,47]. ASRM reports that research for uterine polyps in women with gestational loss is controversial as there is no conclusive evidence that surgical treatment reduces the risk of gestational loss [49].…”

Nationwide population-based cohort study of adverse obstetric outcomes in pregnancies with myoma or following myomectomy: Retrospective cohort study

“…4 Because there is insu cient evidence that myomectomy improves pregnancy outcomes, academic societies including the American Society for Reproductive Medicine (ASRM) and the Society of Obstetricians and Gynaecologists of Canada (SOGC) are against myomectomy in asymptomatic women with non-cavity-distorting myomas. 5,6 Nevertheless, in US Census Bureau population projections, it was estimated that myomectomies are predicted to increase 31% between 2007 and 2050. 7 In Korea, the number of women who underwent myomectomy have increased 37.3% between 2006 and 2010.…”