Uterine fibroids and infertility: a controverse but concrete link

Aleksandar Dmitrović,Andrea Tinelli,Jelena Štulić,Lazar Nejković,Mladen Andjić,Radmila Sparić,Radomir Aničić,Zagorka Milovanović,Đina Tomašević

doi:10.31083/j.ceog4901018

Abstract

Background: Uterine fibroids (UFs) are the most common female benign tumors linked to significant morbidity. There are large literature data connecting UFs with infertility and adverse pregnancy outcome. In this research, authors reviewed literature on UFs, analyzing their relationship with infertility, influence of different therapeutic approaches of UFs on fertility and the possible mechanisms related to UFs and infertility. Methods: MEDLINE and PubMed search, during the years 1990–2020 was performed using a combination of keywords on such topic. Peer-reviewed, systematic review, meta-analysis and prospective trials, examining relationship between UFs and infertility were included in this investigation. According to authors evaluation, additional articles were also identified from the retrieved papers references and included in this narrative review. Results: UFs, especially the submucous and intramural types, with related treatments are linked to impairment of fertility and adverse pregnancy outcome, but many data are conflicting. Molecular mechanisms investigations could explain relationship between UFs and infertility. Conclusion: UFs are linked to infertility and interventions improve fertility. However, many studies conflict in the final results, so further investigations on UFs and infertility should clarify the exact role of molecular mechanisms of this association.

Highlights

Uterine fibroids (UF) or leiomyoma represents the most common benign tumors in women of reproductive age, their pathophysiology as well as mechanism included in their onset are still unclear [1]
When compared with the control group, women with UFs >4 cm had significantly higher endometrial vascularity index (VI), flow index (FI) and vascularization flow index (VFI), whereas women with UF ≤4 cm had no statistically significant differences in VI, FI, and VFI. These findings indicated that intramural UFs >4 cm significantly increase endometrial vascularity and that increase in blood flow could be a factor that affects the outcome of in vitro fertilization (IVF)
There is a lack of quality studies which could give strong information on the link between infertility and UFs

Summary

Introduction

Uterine fibroids (UF) or leiomyoma represents the most common benign tumors in women of reproductive age, their pathophysiology as well as mechanism included in their onset are still unclear [1]. Uterine fibroids (UFs) are the most common female benign tumors linked to significant morbidity. There are large literature data connecting UFs with infertility and adverse pregnancy outcome. Results: UFs, especially the submucous and intramural types, with related treatments are linked to impairment of fertility and adverse pregnancy outcome, but many data are conflicting. Molecular mechanisms investigations could explain relationship between UFs and infertility. Many studies conflict in the final results, so further investigations on UFs and infertility should clarify the exact role of molecular mechanisms of this association

Methods

Findings

Discussion

Conclusion