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Intramural leoimyoma without endometrial cavity distortion may negatively affect the ICSI - ET outcome.

Guven S, Kart C, Unsal MA, Odaci E - Reprod. Biol. Endocrinol. (2013)

Bottom Line: In fibroid group the implantation rate was significantly lower than control group (20.97 +/- 37.93 vs.32.89 +/- 43.18%, p = 0.04).However, spontaneous abortion rate was higher in fibroid group but it did not reach the significant level (12.5% vs. 9.2%, p > 0.05).Women having intramural leiomyomas not encroaching on the uterine cavity have unfavorable ICSI/ET outcomes comparable to those of women without such leiomyomas.

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Affiliation: Department of Obstetrics and Gynecology, Farabi ART Center, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey. drsuleymanguven@yahoo.com.

ABSTRACT

Background: To assess the impact of intramural fibroids on the intracytoplasmic sperm injection-embryo transfer (ICSI-ET) cycle outcome, when there is no compression of the endometrial cavity.

Methods: In this retrospective, matched control study, the ICSI-ET outcome of sixty-two patients (Group I) with intramural fibroid (mean diameter <7 cm) and normal endometrial cavity demonstrated by office hysteroscopy was compared with matched-control group of patients (n = 301) with no fibroid (Group II). The diagnosis of fibroids was done by transvaginal ultrasonography.

Results: The mean age in fibroid group was 32.66 +/- 5.30 while this figure was 32.95 +/- 3.98 in control group. The clinical pregnancy rate was significantly lower in the fibroid group although fibroids not distorting the uterine cavity (25.8% vs. 39.9%, p = 0.04). In fibroid group the implantation rate was significantly lower than control group (20.97 +/- 37.93 vs.32.89 +/- 43.18%, p = 0.04). However, spontaneous abortion rate was higher in fibroid group but it did not reach the significant level (12.5% vs. 9.2%, p > 0.05).

Conclusion: Women having intramural leiomyomas not encroaching on the uterine cavity have unfavorable ICSI/ET outcomes comparable to those of women without such leiomyomas. Therefore, myomectomy may be a good option for such patients with intramural fibroids even they do not have any endometrial distortion.

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Outcomes, meta-analysis results of all reported studies on pregnancy rates in women with intramural fibroids and in a control group (without myoma).
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Figure 1: Outcomes, meta-analysis results of all reported studies on pregnancy rates in women with intramural fibroids and in a control group (without myoma).

Mentions: A recent systematic literature review concerning the effect of fibroids on fertility in patients undergoing ART evaluated six articles and concluded that there was a significant negative impact on implantation rate in the intramural myoma groups vs. the control groups (16.4 vs. 27.7% OR 0.62 (0.48-0.8)). The pregnancy and delivery rates per transfer cycle were also significantly lower in myoma groups. It was concluded that a surgical approach in patients with a history of previous failed attempts with intramural myomata >2 cm in diameter is warranted if all ather factors have been evaluated[9]. Morover, Kolankaya et al. also suggested that there is no consensus for intramural myomas that do not enroach upon the cavity; however, most surgeons would agree to remove them if they are larger than 7 cm or are associated with multiple failed IVF cycles[19]. Only a few reports showed the significant detrimental effect of intramural myoma on ART outcome as detailed in Table 3[5,6,20]. However, meta-analysis results of all reported studies showed the negative effect of fibroid on pregnancy rates (Figure 1, odds ratio 0.737, 95% confidence interval 0.647-0.840, p = 0.000).


Intramural leoimyoma without endometrial cavity distortion may negatively affect the ICSI - ET outcome.

Guven S, Kart C, Unsal MA, Odaci E - Reprod. Biol. Endocrinol. (2013)

Outcomes, meta-analysis results of all reported studies on pregnancy rates in women with intramural fibroids and in a control group (without myoma).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231457&req=5

Figure 1: Outcomes, meta-analysis results of all reported studies on pregnancy rates in women with intramural fibroids and in a control group (without myoma).
Mentions: A recent systematic literature review concerning the effect of fibroids on fertility in patients undergoing ART evaluated six articles and concluded that there was a significant negative impact on implantation rate in the intramural myoma groups vs. the control groups (16.4 vs. 27.7% OR 0.62 (0.48-0.8)). The pregnancy and delivery rates per transfer cycle were also significantly lower in myoma groups. It was concluded that a surgical approach in patients with a history of previous failed attempts with intramural myomata >2 cm in diameter is warranted if all ather factors have been evaluated[9]. Morover, Kolankaya et al. also suggested that there is no consensus for intramural myomas that do not enroach upon the cavity; however, most surgeons would agree to remove them if they are larger than 7 cm or are associated with multiple failed IVF cycles[19]. Only a few reports showed the significant detrimental effect of intramural myoma on ART outcome as detailed in Table 3[5,6,20]. However, meta-analysis results of all reported studies showed the negative effect of fibroid on pregnancy rates (Figure 1, odds ratio 0.737, 95% confidence interval 0.647-0.840, p = 0.000).

Bottom Line: In fibroid group the implantation rate was significantly lower than control group (20.97 +/- 37.93 vs.32.89 +/- 43.18%, p = 0.04).However, spontaneous abortion rate was higher in fibroid group but it did not reach the significant level (12.5% vs. 9.2%, p > 0.05).Women having intramural leiomyomas not encroaching on the uterine cavity have unfavorable ICSI/ET outcomes comparable to those of women without such leiomyomas.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Obstetrics and Gynecology, Farabi ART Center, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey. drsuleymanguven@yahoo.com.

ABSTRACT

Background: To assess the impact of intramural fibroids on the intracytoplasmic sperm injection-embryo transfer (ICSI-ET) cycle outcome, when there is no compression of the endometrial cavity.

Methods: In this retrospective, matched control study, the ICSI-ET outcome of sixty-two patients (Group I) with intramural fibroid (mean diameter <7 cm) and normal endometrial cavity demonstrated by office hysteroscopy was compared with matched-control group of patients (n = 301) with no fibroid (Group II). The diagnosis of fibroids was done by transvaginal ultrasonography.

Results: The mean age in fibroid group was 32.66 +/- 5.30 while this figure was 32.95 +/- 3.98 in control group. The clinical pregnancy rate was significantly lower in the fibroid group although fibroids not distorting the uterine cavity (25.8% vs. 39.9%, p = 0.04). In fibroid group the implantation rate was significantly lower than control group (20.97 +/- 37.93 vs.32.89 +/- 43.18%, p = 0.04). However, spontaneous abortion rate was higher in fibroid group but it did not reach the significant level (12.5% vs. 9.2%, p > 0.05).

Conclusion: Women having intramural leiomyomas not encroaching on the uterine cavity have unfavorable ICSI/ET outcomes comparable to those of women without such leiomyomas. Therefore, myomectomy may be a good option for such patients with intramural fibroids even they do not have any endometrial distortion.

Show MeSH
Related in: MedlinePlus