Advertisement

Fibroids and reproductive outcomes: a systematic literature review from conception to delivery

      We examined the published relationship between uterine fibroids and reproductive outcomes. Submucosal fibroids had the strongest association with lower ongoing pregnancy rates, odds ratio, 0.5; 95% confidence interval, 0.3-0.8, primarily through decreased implantation. Cumulative pregnancy rates appeared slightly lower in patients with intramural fibroids 36.9% vs 41.1%, which may reflect biases in the literature; however, patients with intramural fibroids also experienced more miscarriages, 20.4% vs 12.9%. Adverse obstetric outcomes are rare and may reflect age or other differences in fibroid populations. Increased risk of malpresentation (odds ratio, 2.9; 2.6-3.2), cesarean (odds ratio, 3.7; 3.5-3.9), and preterm delivery (odds ratio, 1.5; 1.3-1.7) are reported; however, the incidence of labor dystocia was low (7.5%). There was no conclusive evidence that intramural or subserosal fibroids adversely affect fecundity. More prospective, controlled trials are needed to assess the effects of myomectomy. Good maternal and neonatal outcomes are expected in pregnancies with uterine fibroids.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Practice Committee of the ASRM
        Myomas and reproductive function.
        Fertil Steril. 2004; 82: S111-S116
        • Marshall L.M.
        • Spiegelman D.
        • Barbieri R.L.
        • Goldman M.B.
        • Manson J.E.
        • Colditz G.A.
        • et al.
        Variation in the incidence of uterine leiomyoma among premenapausal women by age and race.
        Obstet Gynecol. 1997; 90: 967-973
        • Chen C.R.
        • Buck G.M.
        • Courey N.G.
        • Perez K.M.
        • Wactawski-Wende J.
        Risk factors for uterine fibroids among women undergoing tubal sterilization.
        Am J Epidemiol. 2001; 153: 27-29
        • Qidway I.G.
        • Caughey A.B.
        • Jacoby A.F.
        Obstetric outcomes in women with sonographically identified uterine leiomyomas.
        Obstet Gynecol. 2006; 107: 376-382
        • Ramzy A.M.
        • Sattar M.
        • Amin Y.
        • Mansour R.T.
        • Serour G.I.
        • Aboulghar M.A.
        Uterine myomata and outcome of assisted reproduction.
        Hum Reprod. 1998; 13: 198-202
        • Klatsky P.C.
        • Lane D.R.
        • Ryan I.
        • Fujimoto V.Y.
        The effect of intramural and subserosal fibroids on ART outcomes independent of ovarian age.
        Hum Reprod. 2007; 22: 521-526
        • Farhi J.
        • Ashkenazi J.
        • Feldberg D.
        • Dicker D.
        • Orvieto R.
        • Ben Rafael Z.
        The effects of uterine leiomyomata on in-vitro fertilization treatment.
        Hum Reprod. 1995; 10: 2576-2578
        • Rosenfeld D.L.
        Abdominal myomectomy for otherwise unexplained infertility.
        Fertil Steril. 1986; 46: 328-330
        • Elder-Geva T.
        • Meagher S.
        • Healy D.L.
        • Maclachlan V.
        • Breheny S.
        • Wood C.
        Effect of intramural, subserosal, and submucosal uterine fibroids on the outcome of assisted reproductive technology treatment.
        Fertil Steril. 1998; 70: 687-691
        • Pritts E.A.
        Fibroids and Infertility: a systematic review.
        Obstet Gynecol Surv. 2001; 56: 483-491
        • Shokeir T.A.
        Hysteroscopic management in submucous fibroids to improve fertility.
        Arch Gynecol Obstet. 2005; 273: 50-54
        • Narayan R.
        • Rajat
        • Goswamy K.
        Treatment of submucous fibroids, and outcome of assisted conception.
        J Am Assoc Gynecol Laparosc. 1994; 1 (?): 307-311
        • Surrey E.S.
        • Minjarez D.A.
        • Stevens J.M.
        • Schoolcraft W.B.
        Effect of myomectomy on the outcome of assisted reproductive technologies.
        Fertil Steril. 2005; 83: 1473-1479
        • Casini M.L.
        • Rossi F.
        • Agostini R.
        • Unfer V.
        Effects of the position of fibroids on fertility.
        Gynecol Endocrinol. 2006; 22: 106-109
        • Stovall D.W.
        • Parrish S.B.
        • Van Voorhis B.J.
        • Hahn S.J.
        • Sparks A.E.T.
        • Syrop C.H.
        Uterine leiomyomas reduce the efficacy of assisted reproduction cycles.
        Hum Reprod. 1998; 13: 192-197
        • Hart R.
        • Khalaf Y.
        • Yeong C.T.
        • Seed P.
        • Taylor A.
        • Braude P.
        A prospective controlled study of the effect of intramural uterine fibroids on the outcome of assisted conception.
        Hum Reprod. 2001; 16: 2411-2417
        • Surrey E.S.
        • Lietz A.K.
        • Schoolcraft W.B.
        Impact of intramural leiomyomata in patients with a normal endometrial cavity on in vitro fertilization-embryo.
        Fertil Steril. 2001; 75: 405-410
        • Jun S.H.
        • Ginsurg E.S.
        • Racowsky C.
        • Wise L.A.
        • Hornstein M.D.
        Uterine leiomyomas and their effect on in vitro fertilization outcome.
        J Assist Reprod Genet. 2001; 18: 139-143
        • Yarali H.
        • Bukulmez O.
        The effect of intramural and subserous uterine fibroids on implantation and clinical pregnancy rates in patients having intracytoplasmic sperm injection.
        Arch Gynecol Obstet. 2002; 266: 30-33
        • Check J.H.
        • Choe J.K.
        • Lee G.
        • Dietterich C.
        The effect on IVF outcome of small intramural fibroids not compressing the uterine cavity as determined by a prospective matched control study.
        Hum Reprod. 2002; 17: 1244-1248
        • Wang W.
        • Check J.H.
        Effect of corporal fibroids on outcome following embryo transfer in donor embryo recipients.
        Clin Exp Obstet Gynecol. 2004; 31: 263-264
        • Oliveira F.G.
        • Abdelmassih V.G.
        • Diamond M.P.
        • Dozortsey D.
        • Melo N.R.
        • Abdelmassih R.
        Impact of subserosal and intramural fibroids that do not distort the endometrial cavity on the outcome of in vitro fertilization-intracytoplasmic sperm injection.
        Fertil Steril. 2004; 81: 582-587
        • Buletti C.
        • De Ziegler D.
        • Polli V.
        • Flamigni C.
        The role of leiomyomas in infertility.
        J Am Assoc Gynecol Laparosc. 1999; 6: 441-445
        • Benson C.B.
        • Chow J.S.
        • Chang-Lee W.
        • Hill J.A.
        • Doubilet P.M.
        Outcome of pregnancies in women with uterine leiomyomas identified by sonography in the first trimester.
        J Clin Ultrasound. 2001; 29: 261-264
        • Gianaroli L.
        • Gordts S.
        • D’Angelo A.
        • Magli M.C.
        • Brosens I.
        • Cetera C.
        • et al.
        Effect of inner myometrium fibroid on reproductive outcome after IVF.
        Reprod Biomed Online. 2005; 10: 473-477
        • Khalaf Y.
        • Ross C.
        • El-Toukhy T.
        • Hart R.
        • Seed P.
        • Braude P.
        The effect of small intramural uterine fibroids on the cumulative outcome of assisted conception.
        Hum Reprod. 2006; 21: 2640-2644
        • Feinberg E.C.
        • Larsen F.W.
        • Catherino W.H.
        • Zhang J.
        • Armstrong A.Y.
        Comparison of assisted reproductive technology utilization and outcome between Caucasian and African American patients in an equal-access-to-care setting.
        Fertil Steril. 2006; 85: 888-894
        • Buttram Jr, V.C.
        • Reiter R.C.
        Uterine leiomyomata: etiology, symptomology, and management.
        Fertil Steril. 1981; 36: 433-445
        • Li T.C.
        • Motimer R.
        • Cooke I.D.
        Myomectomy: a retrospective study to examine performance before and after surgery.
        Hum Reprod. 1999; 14: 1735-1740
        • Benson C.B.
        • Chow J.S.
        • Chang-Lee W.
        • Hill J.A.
        • Doubilet P.M.
        Outcome of pregnancies in women with uterine leiomyomas identified by sonography in the first trimester.
        J Clin Ultrasound. 2001; 29: 261-264
        • Exacoustos C.
        • Rosati P.
        Ultrasound diagnosis of uterine myomas and complications in pregnancy.
        Obstet Gynecol. 1993; 82: 97-101
        • Katz V.L.
        • Dotters D.J.
        • Droegemueller W.
        Complications of uterine leiomyomas in pregnancy.
        Obstet Gynecol. 1989; 73: 593-596
        • Norton M.
        • Merril J.
        • Cooper B.A.
        • Kuller J.A.
        • Clyman R.I.
        Neonatal complications after administration of indomethecin for preterm labor.
        N Engl J Med. 1993; 329: 1602-1607
        • Neiger R.
        • Sonek J.D.
        • Croom C.S.
        • Ventolini G.
        Pregnancy related changes in the size of uterine leiomyomas.
        J Reprod Med. 2006; 51: 671-674
        • Aharoni A.
        • Reiter A.
        • Golan D.
        • Paltiey Y.
        • Scharff M.
        Patterns of growth of uterine leiomyomas during pregnancy: a prospective longitudinal study.
        BJOG. 1988; 95: 510-513
        • Lev-Toaff A.S.
        • Coleman B.J.
        • Arger P.H.
        • Mintz M.Z.
        • Arenson R.L.
        • Toaff M.E.
        Leiomyomas in pregnancy: a sonographic study.
        Radiology. 1987; 164: 375-380
        • Muram D.
        • Gillieson M.
        • Walters J.H.
        Myomas of the uterus in pregnancy: ultrasonographic follow-up.
        Am J Obstet Gynecol. 1980; 138: 16-19
        • Rice J.P.
        • Kay H.H.
        • Mahoney B.S.
        The clinical significance of uterine leiomyomas in pregnancy.
        Am J Obstet Gynecol. 1989; 160: 1212-1216
        • Qidwai I.G.
        • Caughey A.B.
        • Jacoby A.F.
        Obstetric outcomes in women with sonographically identified uterine leiomyomata.
        Obstet Gynecol. 2006; 107: 376-382
        • Coronado G.D.
        • Marshall L.M.
        • Schwartz S.M.
        Complications in pregnancy, labor, and delivery with uterine leiomyomas: a population-based study.
        Obstet Gynecol. 2000; 95: 764-769
        • Vergani P.
        • Ghidini A.
        • Strobelt N.
        • Roncaglia N.
        • Locatelli A.
        • Lapinski R.H.
        • et al.
        Do uterine leiomyomas influence pregnancy outcome?.
        Am J Perinatol. 1994; 11: 356-358
        • Vergani P.
        • Locatelli A.
        • Ghidini A.
        • Andreani M.
        • Sala F.
        • Pezullo J.C.
        Large uterine leiomyomata and risk of cesarean delivery.
        Obstet Gynecol. 2007; 109: 410-414
        • Davis J.L.
        • Ray-Mazumder S.
        • Hobel C.J.
        • Baley K.
        • Sassoon D.
        Uterine leiomyomas in pregnancy: a prospective study.
        Obstet Gynecol. 1990; 75: 41-44
        • Sheiner E.
        • Bashiri A.
        • Levy A.
        • Hershkovitz R.
        • Katz M.
        • Mazor M.
        Obstetric characteristics and perinatal outcome of pregnancies with uterine leiomyomas.
        J Reprod Med. 2004; 49: 182-186
        • Roberts W.E.
        • Fulp K.S.
        • Morrison J.C.
        • Martin Jr, J.N.
        The impact of leiomyomas on pregnancy.
        Aus N Z J Obstet Gynaecol. 1999; 39: 43-47
        • American College of Gynecology
        Committee Opinion Number 293.
        The College, Washington, DC2004
        • Walker W.J.
        • McDowell S.J.
        Pregnancy after uterine artery embolization for lyomyomata: a series of 56 completed pregnancies.
        Am J Obstet Gynecol. 2006; 195: 1266-1271
        • Pron G.
        • Mocarski E.
        • Bennett J.
        • Vilos G.
        • Common A.
        • Vanderburgh L.
        Pregnancy after uterine artery embolization for leiomyomata: the Ontario multicenter trial.
        Obstet Gynecol. 2005; 105: 67-76
        • Goldberg J.
        • Pereira L.
        • Berghella V.
        • Diamond J.
        • Daraï E.
        • Seinera P.
        • et al.
        Pregnancy outcomes after treatment for fibromyomata: uterine artery embolization versus laparoscopic myomectomy.
        Am J Obstet Gynecol. 2004; 191: 18-21
        • Dickersin K.
        • Min Y.I.
        Publication bias: the problem that won’t go away.
        Ann NY Acad Sci. 1993; 703: 135-146
        • Decullier E.
        • Lheritier V.
        • Chapuis F.
        Fate of biomedical research protocols and publication bias in France: retrospective cohort study.
        BMJ. 2005; 331;: 191-196