Abstract
There is much discussion about the effect of uterine leiomyomas on the outcomes of assisted reproductive technologies (ART). This study aimed to analyze the effectiveness of in vitro fertilization following the use of a therapy scheme we propose to treat infertility with the background of uterine leiomyoma. The therapy scheme includes the use of a releasing hormone agonist, hysteroresectoscopy or conservative myomectomy and pre-pregnancy pre-treatment. The clinical study involved 175 women of reproductive age who had been diagnosed with uterine leiomyoma, and were divided into the groups as follows. The treatment group A included 137 women with uterine leiomyoma, and was further divided into subgroups. Subgroup A1 included 55 women with uterine leiomyoma after conservative myomectomy who underwent the proposed treatment scheme (TS); A2 included 45 women with uterine leiomyoma after hysteroresectoscopy who underwent the TS; A3 included 37 women with uterine leiomyoma who underwent the TS but not the surgical removal of uterine leiomyoma. Control group B included 38 women with uterine leiomyoma after conservative myomectomy. All patients with intramural and submucosal myoma nodules underwent a hormonal preparatory treatment with a gonadotropin-releasing hormone (GnRH) agonist (Diphereline 3.75 mg intramuscularly once every 28 days for 3 months) prior to the myomectomy. After the surgery, patients were prescribed a combination therapy with a vitamin complex FT 500 plus, vitamin D3 and Pelvidol for three months before and during controlled ovarian stimulation (COS) protocol up to the follicle puncture. We determined that the incidence of pregnancy was the lowest (37.8 %) in women with infertility against the background of uterine leiomyoma, who surgically treated for the myomas, but underwent pre-pregnancy pre-treatment. The frequency of pregnancy did not differ between the A1 and A2 treatment groups, and was on average 7.0 % higher than in the control group, and 11.0 % higher than in the A3 group. The relative incidence of clinical pregnancies was the highest in A1 (45.5 %) and A2 (44.4 %) treatment groups. The frequency of live births in the A1 group was significantly higher than in A3 group (by 14.0 %), while the relative number of term live births in the A1 group exceeded that of A3 group by 26.0 %. Thus, both proposed therapy schemes to treat infertility against the background of uterine leiomyoma, which include the use of a releasing hormone agonist, either a conservative myomectomy or hysteroresectoscopy and pre-pregnancy pre-treatment in addition to the ART protocol with a multi-vitamin complex with inositol, vitamin D3, alpha-lipoic acid and magnesium, had the equivalent effects on the incidence of clinical pregnancy, however the frequency of live births was highest after conservative myomectomy (84.0 %).
Highlights
Current research data addressing the issue of uterine leiomyoma and its impact on female reproductive function indicate that uterine leiomyoma is a hormone-dependent benign formation of the myometrium
The group A was further sub-divided into the following subgroups: A1 - 55 women with uterine leiomyoma after conservative myomectomy who underwent treatment according to the proposed treatment scheme (TS), A2 - 45 women with uterine leiomyoma after hysteroresescopy and TS, and A3 - 37 women with uterine leiomyoma who did undergo surgical removal of uterine leiomyoma but were administered the medication part of the TS (Fig. 1)
W e used several parameters to evaluate the effectiveness of the proposed scheme to treat infertility against the background of uterine leiomyoma, and which includes administration of a releasing hormone agonist, hysteroresectoscopy or conservative myomectomy and prepregnancy pre-treatment
Summary
Current research data addressing the issue of uterine leiomyoma and its impact on female reproductive function indicate that uterine leiomyoma is a hormone-dependent benign formation of the myometrium. Uterine leiomyomas occur in up to 60 % of women under the age of 40 and in 80 % of women under 50 [17]. Uterine leiomyomas are found in 5 to 10 % of women with infertility and in 1-3 % of cases this pathology is the only factor contributing to infertility [1]. Uterine leiomyoma is the cause of approximately 7 % of recurring miscarriages [15]. Sub-mucosal and intramural myomas in particular cause deformation of the lumen of the uterus and are the specific types of uterine leiomyomas that can reduce fertility [23]. Studies link the presence of sub-mucosal myomas to impaired fertility as well as pregnancy loss, but the effects of intramural myomas on reproductive outcomes are less clear [16]
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