The role of myomectomy in fertility enhancement

Abstract

Purpose of review: To review current available literature on the relationship between fibroids and infertility with particular emphasis on the benefits of myomectomy. Pregnancy complications related to the presence of these lesions and to their removal are also addressed.

Recent findings: There is a biological plausibility supporting a causal relationship between fibroids and infertility. From a clinical point of view, this association is mostly supported by studies comparing pregnancy rate following IVF in women with and without fibroids. The emerging view is that submucosal, intramural and subserosal fibroids interfere with fertility in decreasing order of importance. There is one randomized controlled trial supporting the benefits of myomectomy in infertile women with fibroids. The beneficial effects of surgery are further supported by insights from clinical series showing that the pregnancy rate following myomectomy is satisfactory and by the strong benefits documented in the few nonrandomized comparative studies. An increased rate of obstetric complications has been reported in women carrying fibroids. Data regarding the course of pregnancy in operated women are scanty. The most significant (although rare) complication is rupture of the uterus during pregnancy or labour.

Summary: At present, owing to the lack of adequately designed trials aimed to clearly establish that lesions benefit from surgery, a comprehensive and personalized approach should be adopted. The most important variables to be considered are the age of the woman, the characteristics of the fibroids, the concomitant presence of fibroids-related symptoms and the presence of other causes of infertility.