Fibroids: effect on infertility and assisted reproduction

摘要

Uteiine fibroids (leiomyomata) are the most common pelvic tumours found in women Twenty to fifty percent of women are estimated to have fibroids, and theii incidence increases, with age until the time of the menopause There has been considerable speculation that fibroids cause infertility In order to establish causality between pathology and symptoms, it has been suggested that certain criteria must exist These include evidence of benefit in removing fibroids in experimental studies, a strong association between fibroids and infertility, a temporal relationship in detection of the fibroids preceding onset of infertility, the epidemiological and biological plausibility of fibroids causing infertility and whether or not the association of fibroids is specific to infertility Although more than 40 case series of myomectomy have be'en reported, only seven of them are prospective and only one reports a comparison group Another approach to establishing causality in the absence of experimental human studies is to consider the impact of fibroids on assisted reproductive technology (ART) cycles Fibroids have been associated with poor outcomes in assisted reproductive technology cycles However, it is not clear if the position of the fibroid influences the outcome Given the frequency with which fibroids are found, well-designed experimental studies are needed to establish fibroids as a factor in infertility.