Impact of fibroids on fertility rate. Surgical management and obstetric outcome

Abstract

Background. Uterine fibroids are the most common benign tumor in reproductive-age women; when symptomatic, they typically cause pain or pelvic pressure, abnormal uterine bleeding and potential reproductive effects, such as infertility or adverse pregnancy outcome. The intramural and submucosal types produce most prejudice on actual or future pregnancies by distorting the uterine cavity, by affecting the implantation process, as well as by increasing the uterine contractility and producing endometrial inflammation. Myomectomy is cited as the most suitable surgical approach, with benefits and risks. Objectives. To determine the impact of fibroids on fertility rate and the obstetric outcomes of leiomyomas, together with establishing the proper surgical approach for each type, with its benefits. Materials and method. We performed a literature review by searching Cochrane and UpToDate databases, using the keywords: fibroids, fertility, pregnancy, obstetric outcome, myomectomy. Results. Intramural and submucosal fibroids are involved in decreasing implantation and pregnancy rates, with most frequent obstetric outcomes under the form of miscarriage, growth restriction and fetal abnormalities. Myomectomy is suggested to be the best surgical approach for women desiring to preserve fertility, with the possibility to be performed hysteroscopic, laparoscopic or by open surgery, depending on the type, size and clinical picture. Conclusions. Overall, there is an important impact of fibroids on fertility rate and obstetric outcome and hysteroscopic myomectomy performed prior to a pregnancy can improve the fertility rate. The mode of delivery should be individualized in case of myoma and pregnancy.