The Impact of Noncavity-Distorting Intramural Fibroids on the Efficacy of In Vitro Fertilization-Embryo Transfer: An Updated Meta-Analysis

Wang, Xiaodan; Chen, Li; Wang, Hengyu; Li, Qin; Liu, Xiru; Qi, Hongbo

doi:10.1155/2018/8924703

Cited by 21 publications

(24 citation statements)

References 40 publications

(48 reference statements)

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“…26 Some women of advanced age who, in the past, underwent ART with their own oocytes are now able to undergo a heterologous fertilization with oocytes of younger donors. Wang et al 23 recently affirmed that no cavitydistorting intramural fibroids would significantly reduce implantation rate, clinical pregnancy rate, and live birth rate and significantly increase the miscarriage rate after IVF treatment, but it would not significantly increase the ectopic pregnancy rate. Kameda et al 24 reported on pregnancy rates in patients with infertility of unknown etiology other than the presence of uterine fibroids, concluding that laparoscopic myomectomy should be recommended in patients with fibroids and no obvious cause for infertility.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Intracapsular Myomectomy in Women 40 Years Old and Over with Symptomatic Uterine Fibroids. A Pilot Study

et al. 2021

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Authors evaluated the impact of laparoscopic intracapsular myomectomy (LIM) in women 40 years of age and over with desire of future fertility compared with medical management of symptomatic fibroids, by a prospective cohort study in University affiliated Hospitals. This study includes a cohort of women 40 years of age and older with symptomatic intramural fibroids with desire of future fertility. Women with symptomatic fibroid uterus were offered to undergo LIM or medical management. They were encouraged to attempt conception either spontaneously or by assisted reproductive technology (ART) according to their individual preference. All women were followed for 2 years. Fibroid characteristics, pre- and post-surgical variables, including surgical complications, days of hospitalization, pregnancy rate, and obstetrical outcomes were collected. A total of 100 patient were included in the analysis. Fifty patients were assigned to the LIM group and 50 to the medical treatment group (MT). Groups were similar regarding age (43.5 ± 2.4 and 43.5 ± 2.4, p = 0.99), body mass index (23.8 ± 3.1 and 24.2 ± 3.1, p = 0.54), parity (0.46 ± 0.09 and 0.58 ± 0.09, p = 0.37), fibroid number (1.38 ± 0.6 and 1.46 ± 0.6, p = 0.53), and fibroid size (5.92 ± 1.62 cm vs. 5.94 ± 1.49 cm, p = 0.949). Of the patients who underwent LIM, 62% conceived within the study period compared with 56% in the control group (p = 0.54). Pregnancy was achieved by ART in 44% of the patients of the LIM group and 30% in control group. There was no significant difference in pregnancy rates among the two groups regarding spontaneous pregnancy rate (p = 0.332), nor in pregnancies obtained by ART with own eggs (p = 0.146) and oocyte or embryo donation (p = 0.821). The take home baby rate was 65% (20/31) in the LIM group and 61% (17/28) in the control group (p = 0.7851). Both groups had similar rate of miscarriage (p = 0.748).Patients 40 years old and over with symptomatic fibroid uterus who undergo LIM have similar subsequent fertility and obstetrical outcomes than women treated with medical management. LIM has no detrimental impact on future fertility in women 40 years old and over.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Intracapsular Myomectomy in Women 40 Years Old and Over with Symptomatic Uterine Fibroids. A Pilot Study

et al. 2021

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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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“…A number of meta-analyses since 2007 reported different conclusions despite mostly including the same studies (2,3,4,5,6,7). This is likely to be the result of differences in the methodology of reviews and inclusion/exclusion criteria that were used.…”

Section: Introductionmentioning

confidence: 99%

“…We will look at six major reviews that analysed the impact of fibroids on reproductive outcomes (2,3,4,5,6,7). Three of these reviews included studies that investigated the impact of all-type fibroids on both spontaneous pregnancies and IVF treatment outcomes (2,3,4), and the other three specifically addressed studies that assessed the impact of intramural fibroids that did not distort the uterine cavity on the outcome of IVF treatment (5,6,7).…”

Section: Introductionmentioning

confidence: 99%

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

Saridogan¹,

Sarıdoğan²

2019

J Turkish German Gynecol Assoc

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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.

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The Impact of Noncavity-Distorting Intramural Fibroids on the Efficacy of In Vitro Fertilization-Embryo Transfer: An Updated Meta-Analysis

Cited by 21 publications

References 40 publications

Laparoscopic Intracapsular Myomectomy in Women 40 Years Old and Over with Symptomatic Uterine Fibroids. A Pilot Study

Laparoscopic Intracapsular Myomectomy in Women 40 Years Old and Over with Symptomatic Uterine Fibroids. A Pilot Study

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

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

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