Fibroids: To Remove or Not
Uterine myomas (leiomyomata, fibroids) are the most common tumor of the reproductive tract, with a cumulative incidence of 70% in women of reproductive age. They are associated with a variety of clinical problems including menorrhagia, pelvic pressure, pregnancy complications, and adverse obstetric outcomes. Likewise, it is clear that fibroids can adversely affect the reproductive outcome. The adverse effects include both a reduction in fertility and an association with early pregnancy complications. Regardless of their location, size, or number, uterine fibroids are found in about 5%–10% of women with infertility. In approximately 1.0%–2.4% of women with infertility, fibroids are the only abnormal findings. Since pregnancy-related concerns depend on the location and size of the leiomyoma, the importance of an in-depth discussion of a management plan between patients and physicians cannot be overemphasized. From several studies, it is concluded that subserosal myomas less than 7 cm in size and intramural myomas less than 4–5 cm in diameter that do not encroach upon the endometrium appear to have little effect on in vitro fertilization (IVF) outcomes. Larger intramural and subserosal myomas present a clinical dilemma, and more studies are needed to clarify a definitive plan for management. Myomectomy should be considered in women affected with submucosal and/or intramural fibroids, encroaching on the cavity, who are pursuing fertility treatments, particularly in cases of previously failed IVF/intracytoplasmic sperm injection cycles.