The Impact and Management of Fibroids for Fertility An Evidence-Based Approach

Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, Building 10 CRC 1-3140, MSC 1109, Bethesda, MD 20892-1109, USA.
Obstetrics and Gynecology Clinics of North America (Impact Factor: 1.38). 12/2012; 39(4):521-33. DOI: 10.1016/j.ogc.2012.09.005
Source: PubMed


Fibroids affect 35% to 77% of reproductive-age women. When selecting a treatment plan for symptomatic fibroids, the fibroid location, size, and number must be considered. Myomectomy remains the preferred method for women with fibroid-related infertility who wish to have children or maintain fertility. Currently available medical therapies reduce symptoms in the short term but may involve side effects when used long term. Initial fertility studies are encouraging but trials are needed. Recent medical advances have led to minimally invasive approaches for women with fibroid disease, but there is a strong demand for additional treatment options.

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Available from: James H Segars, Aug 26, 2014
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    • "Uterine myomas or fibroids are the most common benign tumors of the female genital tract and are estimated to occur in about 30% of women by the age of 35 and in about 70– 80% over the age of 50 [1]. Uterine myomas form the most frequent indication for hysterectomy [2]. "
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    ABSTRACT: Background and Objectives. A new two-step hysteroscopic myomectomy carried out in the office setting and without anesthesia was feasible for the excision of submucous myomas. The objective of this study was to assess whether removal of submucous myomas from the uterine cavity after hysteroscopic laser enucleation is necessary. Methods. Between June 2009 and April 2013, all outpatients with symptomatic myomatosis (bleeding, pelvic pain, and infertility) assessed ultrasonographically were eligible to participate in a prospective study. All patients underwent office hysteroscopic enucleation of submucous myomas. Enucleated myomas were left in the uterine cavity. Neither anesthesia nor antibiotic prophylaxis was used. Results. Sixty-one women (mean age: 47.3 years) were included. Regardless of hysteroscopic localization and grading, all myomas were enucleated. The mean (standard deviation, SD) diameter of the myoma as measured by the ultrasound scan was 22.6 (8.5) mm. In 29 cases (47.5%), the diameter of the resected myoma was >20 mm and in 10 cases (16.4%) >30 mm. After a mean follow-up of 68.2 (16.5) days, none of the patients showed a residual myoma inside the uterine cavity. Conclusions. The present results indicate that leaving laser-enucleated submucous myoma in the uterine cavity is a feasible and safe therapeutic option.
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    ABSTRACT: Epidemiologic data indicate that infertility is a common global problem being diagnosed in approximately one sixth of all couples. One of the reasons responsible for the inability to conceive is the presence of uterine fibroids. Many reports published recently have emphasized the high efficiency of ulipristal acetate in the treatment of uterine fibroids. In June 2012, a 35-year-old woman reported to the Non-Public Health Care Unit "Ovum Reproduction and Andrology" in Lublin for continued treatment of infertility. However, ultrasound performed on the day of the visit at Ovum showed two intramural uterine fibroids: one of them, size 2.26 cm x 2.53 cm, was located in the front uterine wall touching the endometrium and the other one with a diameter of 1.2 cm was located in the posterior uterine wall, not compressing the endometrium. Taking all of this into consideration along with the treatment conducted so far, the couple has been qualified for an ICSI (intracytoplasmic sperm injection) procedure. Due to the presence of the fibroid in the front wall of the uterus, which might have adversely afected embryo implantation in the previous IVF procedures, an attempt was made to reduce the fibroid volume with 3-month treatment with Esmya 5 mg 1 x 1 given for 84 days. Ultrasound performed after discontinuation of Esmya treatment showed normal size of the uterus with smooth contours and the previously detected intramural fibroid located in the posterior wall, was found to have a diameter of 1.08 cm, illustrating a reduction from pre-treatment size. The fibroid located in the front wall of the uterus previously detected by ultrasound was no longer visible. The patient underwent ICSI treatment. The risk of multiple pregnancies was reduced by an appropriate selection of a single blastocyst for transfer. Pregnancy was achieved and further ultrasound confirmed normal anatomical structure of the fetus and the absence of other fibroids.
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    ABSTRACT: Uterusmyome können ein Konzeptionshindernis darstellen und auch in einer bestehenden Schwangerschaft zu Komplikationen führen. Die Arbeit gibt eine Übersicht des aktuellen Kenntnisstandes zu Ätiologie und Therapiemöglichkeiten. Das Evidenzniveau, auf dessen Basis Therapieempfehlungen gegeben werden können, ist aufgrund der unzureichenden Datenlage niedrig. Patientinnen mit unerfülltem Kinderwunsch und submukösen oder intramural/submukösen Myomen scheinen von einer Myomenukleation hinsichtlich der Schwangerschaftsrate zu profitieren. Allerdings sollte diese erst nach Durchführung einer generellen Sterilitätsdiagnostik des Paares erfolgen. Offene und laparoskopische Myomenukleationen scheinen hinsichtlich der Schwangerschaftsrate gleichwertige Verfahren darzustellen. Ein laparoskopisches Vorgehen ist mit weniger perioperativem Blutverlust und Schmerzen sowie schnellerer Rekonvaleszenz assoziiert. Ob sich eine Patientin mit Kinderwunsch, jedoch ohne Sterilitätsanamnese und bekanntem Uterusmyom vor Anstreben der Schwangerschaft einer operativen Therapie unterziehen sollte oder nicht ist unklar. Aufgrund der insgesamt unzureichenden Datenlage scheint sowohl nach hysteroskopischer Myomenukleation als auch nach offener oder laparoskopischer Myomentfernung unter entsprechender Überwachung ein vaginaler Entbindungsversuch möglich.
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