Q: Do fibroids cause infertility?Fibroids are common benign tumors of the uterus. They occur predominantly in premenopausal women, and their growth appears to be hormone (estradiol, progesterone) dependent. They may grow towards the uterine cavity (submucosal) or towards the abdominal cavity (subserosal), or they may be located within the uterine wall (intramural). Fibroids may be asymptomatic or could be associated with a variety of complaints. Symptoms, such as irregular bleeding, pelvic pressure, urinary frequency, constipation, and pain, are associated with size, number, and location of the fibroids.
It has long been suspected that fibroids that distort the uterine cavity (submucosal or intramural) are associated with infertility and miscarriages. The association between fibroids and reproductive failure (infertility, pregnancy loss) has been studied by several groups. However, the majority of these studies have been too small to yield meaningful results. In addition, few studies have addressed the benefits of treatment in a well-designed manner. To further complicate the issue, several treatment options -- medical, surgical, radiologic -- are available, but their effects would need to be assessed separately.
New Research: A Meta-Analysis
This combined analysis is based on the results of 23 studiesthat evaluated fibroids and their effect on reproductive success. The results suggest that fibroids, in general, regardless of location, were associated with a 15% reduction in pregnancy rates, a 30% reduction in live birth rates, and a 67% increase in miscarriage rates when compared with controls without fibroids. The effect was especially pronounced when submucous fibroids were analyzed (64% reduction in pregnancy rates, 69% reduction in live birth rates, and 67% increase in miscarriage rate). The effect of intramural fibroids was significant but less pronounced (22% decrease in live birth rates, 89% increase in miscarriage rates). Subserosal fibroids did not affect pregnancy rates or pregnancy outcome. The analysis did not demonstrate a consistent effect on pregnancy rates and outcomes.
Myomectomy (surgical removal of fibroids) was associated with improved pregnancy outcome when submucosal myomas were evaluated. The pregnancy rate was significantly higher after myomectomy when compared with women with fibroids left in place. On the basis of a small number of cases, the removal of intramural fibroids was not associated with improved pregnancy outcome. More studies of better quality are needed to assess the benefits of removing intramural and subserosal fibroids.
Epub 2008 Mar 12.
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