ABSTRACT
Uterine leiomyomata are common and, not sur prisingly, they are found in a significant propor tion of women with infertility or early pregnancy loss. The presence of one or more leiomyomata is often interpreted as being causal or at least contributing to the reproductive failure in these patients, and the temptation to remove them surgically can be considerable. Mechanical factors, such as distortion of the cervix, occlusion of the tubal ostia, altered myometrial contractility, and impaired endome trial perfusion, are often invoked to explain how leiomyomata affect fertility. However, objective evidence that these mechanisms impair sperm transport or interfere with the implantation process is lacking. Furthermore, in the absence of large and well-controlled studies it is difficult, if not im-possible, to accurately define the impact of leiomyomata on fertility. Nonetheless, there is evidence that submucous leiomyomata adversely affect fertility. It has been suggested that submucous and outer myometrial leiomy omata are two distinct clinicopathological enti ties.1 This chapter examines the classification of uterine leiomyomata and the evidence that links the localization of leiomyomata to reproductive failure, and reviews the role of surgical or medical intervention in infertility.
