Embryo reduction in a myomatous uterus and polypectomy during embryo transfer: Challenges well overcome

Abstract

Fibroids of the uterus, the most common benign pelvic tumors in women, as a sole cause of infertility has been debatable, as the incidence of fibroids as the cause of infertility in the absence of other obvious causes has been reported to be just 2-3%. Thus the management of myomas in the setting of infertility has also been controversial. However myomectomy has been considered ideal in a woman with sub fertility because the surgical removal of fibroid has definitely demonstrated improvement in pregnancy rate especially after assisted reproduction. Assisted Reproductive Technologies have resulted in an increase in the incidence of higher order multiple pregnancies which in turn is complicated by increased perinatal morbidity and mortality. Thus embryo reduction is offered to decrease the complication of prematurity and preterm birth due to multiple gestation. The technique of multifetal pregnancy reduction is not without risks especially in the presence of other pathology like multiple myomas. Herein we present a case of long duration infertility in the presence of multiple fibroids uterus which gets complicated by triplet gestation after IVF. Embryo reduction in the presence of these myomas is is a challenge both to the clinician in terms of the procedure and the patient because of the risks but subsequently has a successful pregnancy outcome.