Fibroids and Pregnancy
Will my fibroids prevent me from getting pregnant? The clinical pregnancy rate (PR) was not different between the two groups (no fibroids vs fibroids) (54% vs 47%). The implantation rate (IR) was also similar between the groups (38% vs 36%). Miscarriage rates were similar (9% vs 15%). Ectopic pregnancy (which is typically a rare outcome) showed results of 1% vs 4%, which also was not statistically significant. Location and diameter of fibroids did not show a significant impact on PR. When screening ultrasounds identify fibroids, treatment of these lesions is tempting to both providers and patients, especially in cases of unexplained infertility. Our data suggest that there is inadequate evidence to conclude that fibroids which do not distort the uterine cavity have a significant effect on clinical pregnancy rates (PR) in patients undergoing IVF. Thus, there is inadequate evidence to support myomectomy for patients with non-distorting fibroids. Myomectomy may unnecessarily place the patient at risk of delayed treatment, as well as possible surgical morbidity. It is also unknown whether surgery itself may have a negative impact on pregnancy outcome- though our data did not show a lower PR in patients who had past myomectomies. Future collaborative studies will investigate whether the distance of the closest fibroid to the uterine lining may impact PR and IR. Fibroid volume will also be investigated. These studies are currently in the design phase. Isabelle Ryan, MD The effects of fibroids without cavity involvement on ART outcomes independent of ovarian age, PC Klasky, DE Lane, IP Ryan, VY Fujimoto, Hum Reprod Advance Access, published September 22, 2006.