The impact of uterine fibroids on reproductive function
Authors:
R. Krajčovičová; R. Hudeček
Authors place of work:
Gynekologicko-porodnická klinika LF MU a FN Brno
Published in the journal:
Prakt Gyn 2010; 14(4): 154-163
Category:
Review
Summary
The paper provides a comprehensive overview of uterine fibroids in the context of female sterility and infertility. A uterine fibroid (myoma, leiomyoma) is the most frequent benign tumour of the uterine body, affecting 30–50% of women aged 30–50 years [1]. In view of the increasing incidence of uterine fibroids among women planning conception, myomas and reproduction disorders are a topical issue. Careful evaluation of a clinical picture and detailed diagnostics of the number, localization and type of myomas should be followed by a consideration on whether or not uterine fibroids in a specific patient are the causal factor of sterility or infertility, to what extend and what therapeutic options are available. Global studies available so far suggest that a myoma exceeding 5 cm and/or situated near the cervix or the utero-tubal junction appears to be a causing factor of sterility [11]. The actual impact on fertility is derived from the close association between uterine myoma and uterine cavity. The only statistically significant impact on the number of clinical pregnancies and live births was shown in association with submucous and intramural fibroids [12]. The traditionally accepted causal relationship between fibroids and abortions is being disputed by some studies, particularly in patients with a solitary myoma. Rather than the size or localization of the leiomyoma, the future of the pregnancy depends on the position of implantation in relation to the myoma [7]. A number of recent studies have confirmed significantly poorer results of assisted reproduction cycles (implantation rate, pregnancy rate, delivery rate) and significant reduction in the success of IVF cycles in women with leiomyoma compared to control groups (most frequently compared to women whose sterility is associated with fallopian tubes), including intramural fibroids not distorting the uterine cavity [4–6]. Laparoscopic or laparotomic myomectomy are the predominant treatment approaches for intramural and subserous myomas. This intervention is recommended in infertile women with diagnosed leiomyoma exceeding 4 cm. Myomectomy is appropriate in very large myomas (above 7 cm) and symptomatic myomas (menometrorrhagia) in women with multifactorial cause of infertility [7]. Hysteroscopic myomectomy is recommended in submucous myomas exceeding 3 cm and distorting the uterine cavity. Literature suggests that this method provides significant increase in live birth rate [34]. We discuss the correlation between performed myomectomy and an outcome of assisted reproduction. Many global studies confirm usefulness of myectomy performed prior to in vitro fertilization cycle [4,6,17,31,35]. Considering the complex relationship between uterine myomatosis and female reproduction, every specific patient case requires individual evaluation, careful assessment of reproductive history, exclusion of other factors of sterility and detailed diagnosis of the localization, number and size of myomas. Only then it will be possible to select an appropriate individualized therapeutic approach for a specific patient.
Key words:
uterine myomatosis – metrorrhagia – habitual abortion – GnRH analogues – myomectomy – heteroscopy – uterine artery embolization – hysterectomy
Zdroje
1. Citterbart K et al. Gynekologie. Praha: Galén 2001.
2. Mára M, Fučíková Z, Mašata M et al. Management děložních myomů u žen ve fertilním věku. Čes Gynek 2003; 68: 30–35.
3. Pluta M et al. Zhoubné nádory děložního těla. Mod Gynek Porod 2000; 9: 661.
4. Eldar-Geva T, Meagher S, Healy DL et al. Effect of intramural, subserosal, and submucosal uterine fibroids on the outcome of assisted reproductive technology treatment. Fertil Steril 1998; 70(4): 687–691.
5. Hart R, Khalaf Y, Yeong CT et al. A prospective controlled study of the effect of intramural uterine fibroids on the outcome of assisted conception. Hum Reprod 2001; 16(11): 2411–2417.
6. Stovall D et al. Uterine leiomyomata reduce the efficacity of assisted reproduction cycles: results of a matched follow-up study. Hum Reprod 1998; 13:192.
7. Mára M, Řežábek K, Živný J. Děložní myom a poruchy plodnosti. Mod Gynek Porod 2002; 11: 614.
8. Krajčovičová R, Hudeček R, Kalvodová J. Diferenciální diagnostika a terapie opakovaných těhotenských ztrát – 1. část. Prakt Gyn 2007; 11(4): 164–168.
9. Bajekal N, Li T C. Fibroids, infertility and pregnancy wastage. Hum Reprod Update 2000; 6: 614.
10. Kučera E, Živný J. Sterilita při děložním myomu a její ovlivnění operační léčbou. Čes Gynek 1997; 42: 324.
11. Mára M, Holub Z et al. Děložní myomy – moderní diagnosti a léčba. Praha: Grada 2009.
12. Venkat G, Amiri N, Al-nasser R et al. The effect of submucosal, intramural and subserosal sterine fibroids on the pregnancy. Outcome in ovocyte recipients. Fertil Steril 2005; 84: S258.
13. Zwinger A. Spontánní a opakovaný potrat. Mod Gynek Porod 2000; 9: 367.
14. Bajekal N, Li TC. Fibroids, infertility and pregnancy wastage. Hum Reprod 2000; 6(6): 614–620.
15. Benson CB et al. Outcome of pregnancies in women with uterine leiomyomas identified by sonography in the first trimester. J Clin Ultrasound 2001; 29(5): 261–264.
16. Bernard G, Darai E, Poncelet C et al. Fertility after hysteroscopic myomectomy: effect of intramural myomas associated. Eur J Obstet Gynecol Reprod Biol 2000; 88(1): 85–90.
17. Farhi J, Ashkenazi J, Feldberg D et al. Effect of uterine leiomyomata on the results of in-vitro fertilization treatment. Hum Reprod 1995; 10(10): 2576–2578.
18. Dietterich C et al. The presence of small uterine fibroids not distorting the endometrial cavity does not adversely affect conception outcome following embryo transfer in older recipients. Clin Exp Obstet Gynecol 2000; 27: 168–170.
19. De Leo V, Morgante G, La Marca A et al. A benefit-risk assessment of medical treatment for uterine leiomyomas. Drug Staf 2002; 25(11): 759–779.
20. Friedman AJ, Rein MS, Harrison-Atlas D et al. A randomized, placebo controlled, double blind study evaluating leuprolide acetate depot traetment efore myomectomy. Steril Fertil 1989; 52(5): 728–733.
21. Golan A. GnRH analogues in the traetment of sterine fibroids. Human Repris 1996; 11(3): 33–41.
22. Hudeček R, Ventruba P, Crha I. Podpůrná hormonální léčba v programu asistované reprodukce. Prakt Gyn 2005; 9(5): 6–8.
23. Gerhard I, Mastthes J, Runnebaum B. The induction of ovulation with pulsatile gonadotrophin releasing hormone administration in hyperandrogenic women after down-regulation with buserelin or suppresion with an oral contraceptive. Hum Reprod 1993; 8(12): 2033–2038.
24. Pánková S, Hudeček R, Račanská E. Peroperační prevence adhesí v gynekologii. Prakt Gyn 2009; 13(2): 70–75.
25. Mára M. Současné možnosti léčby děložních myomů. Mod Bab 2007; 13: 1–7.
26. Bulletti C et al. The role of leiomyomas in infertility. J Am Assoc Gynecol Lapar 1999; 6: 441–445.
27. Dubuisson JB, Fauconnier A, Chapron C et al. Reproductive outcome after laparoscopic myomectomy in infertile women. J Reprod Med 2000; 45(1): 23–30.
28. Li TC, Mortimer R, Cooke ID et al. Myomectomy: a retrospective study to examine reproductive performance before and after surgery. Hum Reprod 1999; 14(7): 1735–1740.
29. Smith DC, Uhlir JK. Myomectomy as a reproductive procedure. Am J Obstet Gynecol 1990; 162(6): 1476–1482.
30. Poncelet C et al, Benifla JL, Batallan A. Myoma and infertility: analysis of the literature. Gynecol Obstet Fertil 2001; 29(6): 413–421.
31. Dubuisson JB et al. Myomectomy: It´s Role in Infertility. Proceedings of the 2nd World Congress on Controversies in Obsterics, Gynecology & Infertility. Paris, September 2001.
32. Tulandi T, Murray C, Guralnick M et al. Adhesion formation and reproductive outcome after myomectomy and second-look laparoscopy. Obstet Gynecol 1993; 82(2): 213–215.
33. Vercellini P, Maddalena S, De Giorgi O et al. Determinants of reproductice outcome after abdominal myomectomy for infertility. Fertil Steril 1999; 72(1): 109–114.
34. Fernandez H, Sefrioui O, Virelizier C et al. Hysteroscopic resection of submucosal myomas in patients with infertility. Hum Reprod 2001; 16(7): 1489–1492.
35. Narayan R, Rajat, Goswamy K. Treatment of submucous fibroids, and outcome of assisted conception. J Am Assoc Gynecol Laparosc 1994; 1: 307–311.
36. Fernandez H. Infertilité et petit myome: role de la myomectomie. Contracept Fertil Sex 1997; 25: 348–349.
37. Jun SH, Ginsburg ES, Racowsky C et al. Uterine leiomyomas and their effect on in vitro fertilization outcome: a retrospective study. J Assist Reprod Genet 2001; 18(3): 139–143.
38. Lumsden MA, Wallace EM. Clinical presentation of uterine fibroids. Baillieres Clin. Obstet Gynaecol 1998; 12(2): 177–195.
Štítky
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineČlánok vyšiel v časopise
Practical Gynecology
2010 Číslo 4
Najčítanejšie v tomto čísle
- Date rape
- The effect of tadalafil treatment on sperm count in men with erectile dysfunction
- The impact of uterine fibroids on reproductive function
- Sexual life in pregnancy – assessment by the SFW questionaire (Sexual Function of a Woman)