4. The effect of intramural uterine fibroids on the outcome of assisted conception.
Uterine fibroids occur in 30% of women and are associated with a degree of subfertility. Their effect on the outcome of IVF or ICSI treatment, however, has not been prospectively studied. Data were prospectively collected on 434 women undergoing IVF/ICSI. Patients were assessed for the presence of fibroids by transvaginal ultrasound and hysterosonography or hysteroscopy where appropriate. During the study period, 112 women with (study), and 322 women without (controls), intramural fibroids were treated. Patients were similar regarding the cause and duration of their infertility, number of previous treatments, and basal serum FSH concentration. Women in the study group were on average 2 years older (36.4 versus 34.6 years; P < 0.01). There was no significant difference in the duration of ovarian stimulation or gonadotrophin requirement, number of follicles developed, oocytes collected, embryos available for transfer or replaced. When analysing only women with intramural fibroids of <=5 cm in size (n = 106) pregnancy, implantation and ongoing pregnancy rates were significantly reduced. The mean size of the largest fibroids was 2.3 cm (90% range 2.1-2.5 cm). Logistic regression analysis demonstrated that the presence of intramural fibroids was one of the significant variables affecting the chance of an ongoing pregnancy, even after controlling for the number of embryos available for replacement and increasing age. The results of the study demonstrate that an intramural fibroid halves the chances of an ongoing pregnancy following assisted conception.
Hart R, Khalaf Y, Yeong C-T, Seed P, Taylor A, Braude P (2001)
A prospective controlled study of the effet of intramuralo uterine fibroids on the outcome of assisted conception. Hum. Reprod. 2411-2417