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Myomas, Pregnancy Outcome, and In Vitro Fertilization
aInstitute of Obstetrics and Gynecology, Reproductive Pathophysiology Unit, Alma Mater Studiorum, University of Bologna - Rimini Health Care Unit, Internal Hospital, Rimini, Italy bReproduction Endocrinology and Infertility Division, Department of Obstetrics and Gynecology, University Hospital of Geneva, Geneva, Switzerland cOperative Unit of Reproductive Medicine, Humanitas Clinical Institute, Milan, Italy dDepartment of Obstetrics and Gynecology, University of Bari, Bari, Italy
Address for correspondence: Carlo Bulletti, Institute of Obstetrics and Gynecology, Reproductive Pathophysiology Unit, Alma Mater Studiorum, University of Bologna-Rimini Health Care Unit, Internal Hospital, Via Settembrini, 2, 47900 Rimini, Italy. Voice: 39.0541705741; fax: +39.0541958742. bulletticarlo{at}libero.it
Uterine fibroids have been reported in 27% of infertile women, and 50% of women with unexplained infertility become pregnant after myomectomy. The age at which a first pregnancy occurs is increasing from the thirties to the forties. This increase and the recurrence rate of leiomyomas from 15 to 30% points to the effect of myomas on the infertility. Mechanisms by which myomas may cause infertility are abnormal uterine contractility, elongation of the uterine cavity, and distortion of uterine vascularization. Surgery may have beneficial or adverse effects without clear data on its effect on the assisted reproductive technology (ART) procedures. The present study was undertaken to establish the impact of surgical removal of myomas on fertility and infertility of patients undergoing ART procedures. Patients who underwent surgical removal of myomas before in vitro fertilization (Group A) had a cumulative success rate of 33% for one to three procedures (28 clinical pregnancies in 84 patients) and delivery rate of 25% (21 live births in 84 patients). Patients who underwent in vitro fertilization without previous surgery (Group B) had a 15% clinical pregnancy rate (13 pregnancies in 84 patients) (P < 0.05) and 12% delivery rate (10 deliveries in 84 pregnancies) (P < 0.05). Abortion rates were 7% (8 deliveries in 84 patients) and 4% (3 deliveries in 84 patients) in Groups A and B, respectively. This study confirms the beneficial effect of surgical removal of fibroids before undergoing ART procedures.
Key Words: in vitro fertilization • uterine myomas • surgical removal • transvaginal ultrasound • fertility • infertility This article has been cited by other articles:
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