Authors’ Reply

Abstract

It is a pleasure to revisit the role of intramural myomas without a submucosal component in response to the letter by Dr. Dior and colleagues. We too were surprised when we demonstrated that a single intramural myoma without a submucosal component of 2 cm diameter was sufficient to decrease pregnancy outcomes at in vitro fertilization (IVF) [ 1 Behbehani S Polesello S Hasson J Silver J Son WY Dahan M The effect of intramural myomas without an intracavity component on in vitro fertilization outcomes in single fresh blastocyst transfer cycles. J Minim Invasive Gynecol. 2018; 25: 1241-1248 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar ]. However, contemporaneous to our study, 2 other groups investigating this same issue were also published. Yan et al [ 2 Yan L Yu Q Zhang YN et al. Effect of type 3 intramural fibroids on in vitro fertilization-intracytoplasmic sperm injection outcomes: a retrospective cohort study. Fertil Steril. 2018; 109: 817-822 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar ] also demonstrated that a single type 3 (intramural myoma without an intracavitary component) of 2 cm in diameter was sufficient to decrease the implantation, clinical pregnancy, and live birth rates at IVF. In addition, Christopoulos et al [ 3 Christopoulos G Vlismas A Salim R Islam R Trew G Lavery S Fibroids that do not distort the uterine cavity and IVF success rates: an observational study using extensive matching criteria. BJOG. 2017; 124: 615-621 Crossref PubMed Scopus (35) Google Scholar ] demonstrated that a single intramural myoma not entering into the uterine cavity of 3 cm in diameter resulted in decreased pregnancy outcomes. All 3 studies demonstrated a decrease in live birth outcomes in the presence of the single myoma at the cut-off diameter of about 50%. These studies were followed up by a meta-analysis of 28 studies involving 9189 IVF cycles with noncavity-distorting intramural myomas [ 4 Wang X Chen L Wang H Li Q Liu X Qi H The impact of noncavity-distorting intramural fibroids on the efficacy of in vitro fertilization-embryo transfer: an updated meta-analysis. Biomed Res Int. 2018; 8924703 Google Scholar ]. This meta-analysis showed a significant reduction of live birth rates in the study group compared with the control group (relative risk [RR], .82; 95% confidence interval [CI], .73–.92; p = .005). In addition, it indicated that the study group had a significant reduction in clinical pregnancy rate (RR, .86; 95% CI, .80–.93; p = .0001) and the implantation rate (RR, .90; 95% CI, 813–1.00; p = .04) and had a significant increase in the miscarriage rate (RR, 1.27; 95% CI, 1.08–1.50; p = .004) compared with the control group [ 4 Wang X Chen L Wang H Li Q Liu X Qi H The impact of noncavity-distorting intramural fibroids on the efficacy of in vitro fertilization-embryo transfer: an updated meta-analysis. Biomed Res Int. 2018; 8924703 Google Scholar ]. Clearly, based on the findings of the 3 separate studies [ 1 Behbehani S Polesello S Hasson J Silver J Son WY Dahan M The effect of intramural myomas without an intracavity component on in vitro fertilization outcomes in single fresh blastocyst transfer cycles. J Minim Invasive Gynecol. 2018; 25: 1241-1248 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar , 2 Yan L Yu Q Zhang YN et al. Effect of type 3 intramural fibroids on in vitro fertilization-intracytoplasmic sperm injection outcomes: a retrospective cohort study. Fertil Steril. 2018; 109: 817-822 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar , 3 Christopoulos G Vlismas A Salim R Islam R Trew G Lavery S Fibroids that do not distort the uterine cavity and IVF success rates: an observational study using extensive matching criteria. BJOG. 2017; 124: 615-621 Crossref PubMed Scopus (35) Google Scholar ] there is less debate as to whether a single intramural myoma of 2 to 3 cm diameter is sufficient to significantly alter IVF success rates.