Management of fibroids prior to in vitro fertilization/ intracytoplasmic sperm injection: A pragmatic approach

Abstract

Fibroids are relatively common in women undergoing in vitro fertilization (IVF) treatment due to their high prevalence in women. It is generallyaccepted that submucosal fibroids are deleterious to IVF outcomes and their removal is beneficial. Evidence from relatively low quality studies onthe impact of intramural fibroids on IVF outcome is also suggestive of a detrimental impact. The majority of published studies included womenwith relatively small intramural fibroids and women with cavity-distorting fibroids were usually excluded, hence it is quite likely that the detectedimpact in the systematic reviews is an underestimation. Evidence of benefit is scarce for the removal of noncavity-distorting intramural fibroids.It is quite likely that numbers needed to treat for this purpose would be very high for small fibroids but lower for larger fibroids. This would needto be taken into account when decisions are made on myomectomy and potential benefits should be weighed against the associated morbidity,cost, and delay in fertility treatment. Whilst there is a need to perform prospective randomised studies in this field, a pragmatic approach thattakes prognostic factors into account to estimate the magnitude of the possible impact of the fibroid(s) and potential benefit of removal is likelyto lead to better reproductive outcomes. (J Turk Ger Gynecol Assoc 2019; 20: 55-9)