The Effect of Uterine Fibroids on Infertility: A Systematic Review

Rachel M. Whynott, Kamaria C.Cayton Vaught, James Segars

Research output: Contribution to journalReview article

Abstract

Fibroids are present in up to 27% of patients seeking reproductive assistance, and can affect fertility through cavity distortion, alteration of endometrial receptivity, and sexual function. Surgical, noninvasive, and medical approaches have been developed to manage fibroids, but evidence-based data regarding their safety and efficacy for the treatment of infertility and the effects on pregnancy outcome are limited. Myomectomy, through minimally invasive techniques, is the most evidence-based approach to fibroids in women planning conception, and increases pregnancy rates by up to 68% in previously infertile patients. Laparoscopic uterine artery occlusion is under investigation as an alternative and simpler surgical approach to decrease fibroid size. Uterine artery embolization is not recommended for women intending future pregnancy, as the rate of spontaneous abortion (SAB) is up to 64% and the rate of abnormal placentation is 12.5%. Magnetic resonance imaging-guided focused ultrasound surgery is gaining interest as a noninvasive procedure with positive preliminary pregnancy outcomes, but appears to have an SAB rate of 20.6%. Selective progesterone receptor modulators, aromatase inhibitors, and vitamin D supplementation are under investigation to improve uterine conditions for pregnancy. Submucosal and intramural fibroids affect fertility and pregnancy outcomes and should be addressed during infertility workup.

Original languageEnglish (US)
Pages (from-to)523-532
Number of pages10
JournalSeminars in Reproductive Medicine
Volume35
Issue number6
DOIs
StatePublished - Nov 1 2017

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Leiomyoma
Infertility
Pregnancy Outcome
Spontaneous Abortion
Pregnancy Rate
Uterine Myomectomy
Fertility
Fertility Agents
Uterine Artery Embolization
Placentation
Uterine Artery
Aromatase Inhibitors
Induced Abortion
Progesterone Receptors
Vitamin D
Magnetic Resonance Imaging
Safety
Pregnancy

Keywords

  • fertility
  • fibroid
  • infertility
  • myoma

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Reproductive Medicine
  • Endocrinology
  • Obstetrics and Gynecology
  • Physiology (medical)

Cite this

The Effect of Uterine Fibroids on Infertility : A Systematic Review. / Whynott, Rachel M.; Vaught, Kamaria C.Cayton; Segars, James.

In: Seminars in Reproductive Medicine, Vol. 35, No. 6, 01.11.2017, p. 523-532.

Research output: Contribution to journalReview article

Whynott, Rachel M. ; Vaught, Kamaria C.Cayton ; Segars, James. / The Effect of Uterine Fibroids on Infertility : A Systematic Review. In: Seminars in Reproductive Medicine. 2017 ; Vol. 35, No. 6. pp. 523-532.
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