hysteroscopy Myoma surgery

Hysteroscopy and Fertility: Fibroids

 

Fibroids or myomas are benign, monoclonal tumors of the uterus, mostly composed of smooth muscle cells and extracellular matrix. They are the most common solid tumor of the female pelvis. The prevalence varies widely, according to age, ethnicity, family and might be as high as 80% at age 50. They can be asymptomatic, but around 25% of women
might have pain or menorrhagia.Fibroids can be found in up to 10% of infertile women and can be the only abnormal finding in around 2,5%.

A review by Pritts et al. (2009) concluded that fibroids causing intracavitary distortion result in decreased rates of clinical pregnancy, implantation and livebirth, as well as an increased rate of spontaneous miscarriage.

Although no evidence was found against sub-serosal myomas, concerning intramural fibroids the same author concluded that fibroids with no intracavitary involvement,
had also decreased rates of implantation and live birth, and increased rate of spontaneous miscarriage.

Another review by Sunkara (2010) concluded that there was a significant decrease in the live birth in the presence of intramural fibroids that distort the endometrial cavity. Several explanations have been proposed, mostly related to impairment of the uterine peristalsis, vascular flow as well as disruption of sperm and ovum transportation and
embryo implantation.

However other studies are against the conclusion ofPritts, when concerning intra mural fibroids. A cohortstudy by Somigliana with 238 patients comparing the rate of success of IVF in women with small (less than 50mm) fibroids not encroaching the endometrial cavity in asymptomatic patients selected for IVF, concluded that such fibroids did have an impact on the rate of success of the procedure. Bodzag at all. reached the same
conclusion after comparing 61 cases against 444 controls.

In 2015 a Cochrane review addressing this question concluded that probably there might be a trend towards the benefit of removal of submucous fibroids in women with otherwise unexplained subfertility. The odds ratio in a group having regular fertility-oriented intercourse during 12 months for the outcome of clinical pregnancy was 2,44 (95% confidence interval 0.97- 6.17, p=0.06). Concerning miscarriage, there was no evidence of a difference between the groups.

Full article at Hysteroscopy Newsletter

http://www.hysteroscopy.info

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