The Effect of Uterine Fibroids on Infertility: A Systematic Review
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.