Myomectomy decreases abnormal uterine peristalsis and increases pregnancy rate

• Published in: Journal of minimally invasive gynecology Vol. 19; no. 1; p. 63
• Main Authors: Yoshino, Osamu, Nishii, Osamu, Osuga, Yutaka, Asada, Hisanori, Okuda, Shigeo, Orisaka, Makoto, Hori, Masaaki, Fujiwara, Toshihiro, Hayashi, Toshihiko
• Format: Journal Article
• Language: English
• Published: United States 01.01.2012
• Subjects: Adult; Female; Humans; Infertility, Female - etiology; Infertility, Female - physiopathology; Leiomyoma - complications; Leiomyoma - surgery; Luteal Phase - physiology; Magnetic Resonance Imaging, Cine; Peristalsis; Pregnancy; Pregnancy Rate; Uterine Neoplasms - complications; Uterine Neoplasms - surgery; Uterus - physiopathology; Uterus - surgery
• ISSN: 1553-4669
• DOI: 10.1016/j.jmig.2011.09.010

The relationship between fibroids and infertility remains a critical and unresolved question. During the implantation phase, it is known that uterine peristalsis is dramatically reduced, which is thought to facilitate implantation of the embryo to the endometrium. In the previous study, using a cine MRI mode, we found that less than half of the patients with intramural fibroids exhibited abnormal uterine peristalsis during the mid-luteal phase. In the present study, we further investigated whether myomectomy for patients in the high peristalsis group is a constructive method to normalize uterine peristalsis. The frequency of junctional zone movement was evaluated using a cine MRI mode during the mid-luteal phase. Fifteen infertility patients, who had intramural myomas and exhibited abnormal uterine peristalsis (≥2 times/3 min) in their first MRI, underwent myomectomy and a second MRI. After receiving the second MRI, patients underwent infertility treatment for at least 8 months, and pregnancy rate was evaluated prospectively. Among 15 patients, the frequency of uterine peristalsis was normalized (0 or 1 time/3 min) in 14 patients. Following myomectomy and second MRI test, 6 of the 15 patients achieved pregnancy (n = 15, pregnancy rate: 40%). The presence of uterine fibroids might induce abnormal uterine peristalsis in some patients, leading to infertility, and myomectomy may improve fertility in these patients.