The effect of intramural fibroids without uterine cavity involvement on the outcome of IVF treatment: a systematic review and meta-analysis

Sunkara, Sesh Kamal; Khairy, Mohammed; El‐Toukhy, Tarek; Coomarasamy, Arri

doi:10.1093/humrep/dep396

Cited by 288 publications

(173 citation statements)

References 39 publications

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“…Subsequent to our meta-analysis, another meta-analysis [44] was performed, this time including the study by Bozdag et al [43••]. Findings were similar to those in our systematic review.…”

Section: The Datasupporting

confidence: 83%

When Should Uterine Fibroids Be Treated?

Pritts¹,

Olive²

2012

Curr Obstet Gynecol Rep

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Fibroids are a common disorder of women, but in general, are best left untreated unless they are significantly symptomatic or an imminent health hazard. When treatment is needed, surgery remains the gold standard. For fertility, fibroids that impinge upon the uterine cavity should be removed to increase future pregnancy rates. There is no evidence that myomectomy for intramural fibroids, even those as large as 6 cm, increases fertility potential, or improves pregnancy outcome. Prophylactic myomectomy of large fibroids (largest diameter>5 cm) to decrease delivery complications is not recommended because it confers worse outcomes at delivery versus women with these large fibroids in situ. Medical treatment is transient, with most fibroids returning to pretreatment size a few months after treatment is stopped. It may, however, have a place for pretreating women before surgical removal, to treat anemia, or in perimenopausal women. Invasive radiological treatments (eg, uterine artery embolization and magnetic resonance guided ultrasound surgery) are effective for treating fibroids, but must be evaluated further before they can be recommended for women interested in future fertility.

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Section: The Datasupporting

confidence: 83%

When Should Uterine Fibroids Be Treated?

Pritts¹,

Olive²

2012

Curr Obstet Gynecol Rep

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“…The frequency of T-carriers genotypes was found significantly higher among the women with PE than the control groups indicated that MTHFR C677T polymorphism would be expected to play a major role to bring about PE. Some studies reported significantly increased prevalence of MTHFR C677T among cases [22][23][24]49]. In contrast, other 1 9 9 7 J a p a n A s i a n Three meta-analysis summarizing studies on association between the MTHFR C677T polymorphism and the risk of PE until August 2012 have been performed [51][52][53], however, their meta-analysis did not perform analyses on association between the MTHFR A1298C and the risk of PE.…”

Section: Discussionmentioning

confidence: 99%

Folate metabolism gene polymorphisms MTHFR C677T and A1298C and risk for preeclampsia: a meta-analysis

Yang

Tang

et al. 2015

J Assist Reprod Genet

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Objectives MTHFR C677T and A1298C have been associated with the risk of preeclampsia (PE), but with conflicting results. We performed this meta-analysis to derive a more precise estimation of the association between MTHFR polymorphisms and PE. Study design An electronic search of PubMed and Chinese Biomedicine database was conducted to select studies for meta-analysis. 54 case controlled studies containing MTHFR C677T and A1298C gene polymorphisms were chosen, and odds ratio (OR) with confidence interval (CI) was used to assess the strength of this association. Result These studies evaluated 7398 cases and 11230 controls for MTHFR C677T. The overall results suggested that MTHFR C677T was associated with the risk of PE. (T vs. C: OR = 1.157, 95 % CI: 1.057-1.266, p=0.002; TT+CT vs. CC: OR=1.165, 95 % CI 1.049-1.293, P = 0.004; TT vs. CT + CC: OR = 1.371, 95 % CI: 1.153-1.63, p < 0.001). We also evaluated 1103 cases and 988 controls for MTHFR A1298C but could not demonstrate an increased risk of PE for this polymorphism (p=0.667). A symmetric funnel plot, the Egger's test (p = 0.819) suggested a lack of publication bias. ConclusionThis meta-analysis supports the idea that MTHFR C677T genotype is associated with increased risk for PE, especially in the case of Asians and Caucasians.

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“…Literature suggest there is doubtful evidence of performing myomectomy in asymptomatic patients. 19,20 It can be performed laparoscopically or hysteroscopically depending on the location of fibroid. Though uterine septum mostly associated with the recurrent abortion and not with infertility we report an incidence of 42 (12.61%) patients with infertility.…”

Section: Discussionmentioning

confidence: 99%

Role of hysterolaparoscopy for the evaluation of primary infertility: An experience from a tertiary care hospital

Pande

Dora

Pradhan

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONInfertility is one of the most common problem for which couple seeks medical attention. It is seen almost in 10-15% of the reproductive couple.1 Though there are various tests available for the evaluation of the patients with infertility, for the complete evaluation of pelvic pathology hysterolaparoscopy became the gold standard over the years. Ovulatory dysfunction accounts for 21% to 32%, tubal factor 14% to 26%, unexplained 8% to 30% and endometriosis accounts 4% to 6% of female infertility.2-4 Hysterolaparoscopy gives detailed and magnified view of uterine, adenexal, peritoneal and other intra-abdominal pathology. Consequently, milder degree of distal fimbrial pathology, endometriosis, and pelvic adhesions can be diagnosed and treated at the same time which was missed during a routine trans vaginal ultrasonography. The main objective of the study was to assess the role of diagnostic hysterolaparoscopy in the diagnosis and treatment of primary infertility patients. METHODSThis was a hospital based retrospective observational study. Medical records of all cases of primary infertility were retrieved and analyzed. This study was conducted ABSTRACT Background: Infertility is one of the most common problem for which couple seeks medical attention. The main objective of the study was to assess the role of diagnostic hysterolaparoscopy in the diagnosis and treatment of primary infertility patients. Methods: For this retrospective study, patient with the diagnosis of primary infertility were recruited. Patients admitted between the periods 2014 to 2016 were included. Pertinent data related to infertility were collected from the case records and entered in predesigned performa. Results: Patients with primary infertility 246 (82%) diagnosed to have pelvic pathology. The most common cause of infertility was ovarian 122 (36.63%), Uterine 66 (19.82%), tubal 84 (25.22%) and unexplained infertility in 103 (30.93%) women. Patients with PCOS 76 (22.82%) and endometriosis 46 (13.81%) treated with drilling and endometriotic cystectomy. In 32 (9.60%) of patients hysteroscopic cannulation was done. For distal tubal blockage fimbrioplasty was performed in 38 (11.41%) of women. Pelvic adhesions diagnosed in 26 (7.80%) women. patients diagnosed with uterine septum 42 (12.61%) required hysteroscopic septal resection. During the evaluation of infertility 70 (21%) of women diagnosed to have incidental pelvic pathology treated according to pathology. Conclusions: Hysterolaparoscopy is emerging as a valuable technique for complete assessment of female infertility and also helps in treatment according to the cause.

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The effect of intramural fibroids without uterine cavity involvement on the outcome of IVF treatment: a systematic review and meta-analysis

Abstract: The presence of non-cavity-distorting intramural fibroids is associated with adverse pregnancy outcomes in women undergoing IVF treatment.

Cited by 288 publications

References 39 publications

When Should Uterine Fibroids Be Treated?

When Should Uterine Fibroids Be Treated?

Folate metabolism gene polymorphisms MTHFR C677T and A1298C and risk for preeclampsia: a meta-analysis

Role of hysterolaparoscopy for the evaluation of primary infertility: An experience from a tertiary care hospital

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