Impact of intramural leiomyomata in patients with a normal endometrial cavity on in vitro fertilization–embryo transfer cycle outcome

• Published in: Fertility and sterility Vol. 75; no. 2; pp. 405 - 410
• Main Authors: Surrey, Eric S, Lietz, Annette K, Schoolcraft, William B
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2001; Elsevier Science
• Subjects: Adult; Biological and medical sciences; Blastocyst - physiology; Case-Control Studies; Chorionic Gonadotropin - administration & dosage; Embryo Implantation; Embryo Transfer; Endometrium - pathology; Estradiol - blood; Female; Fertilization in Vitro; Follicle Stimulating Hormone - blood; Fundamental and applied biological sciences. Psychology; Humans; hysteroscopy; implantation; in vitro fertilization; Intramural leiomyoma; Leiomyoma - complications; Leiomyoma - pathology; Mother. Fetoplacental unit. Mammary gland. Milk; Pregnancy; Pregnancy Outcome; Pregnancy. Parturition. Lactation; Pulsatile Flow; Regression Analysis; Retrospective Studies; Sperm Injections, Intracytoplasmic; Uterine Neoplasms - complications; Uterine Neoplasms - pathology; Uterus - blood supply; Vertebrates: reproduction; in vitro fertilization; implantation; Intramural leiomyoma; hysteroscopy; Human; Leiomyoma; Hysteroscopy; Leiomyomata; Assisted procreation; Female genital diseases; Pregnancy; In vitro fertilization embryo transfer; Ovum implantation; Uterus; Uterine diseases; Female; Benign neoplasm; Diagnosis
• ISSN: 0015-0282; 1556-5653
• DOI: 10.1016/S0015-0282(00)01714-3

Objective: Assess the impact of intramural uterine leiomyomata and a normal endometrial cavity on IVF-ET cycle outcome. Design: Retrospective case-controlled analysis. Setting: Tertiary-care–assisted reproductive technology program. Patient(s): Three hundred ninety-nine consecutive fresh IVF-ET cycles were performed in patients with a normal precycle diagnostic hysteroscopy; patients were divided into four groups. Group 1: positive leiomyomata, age <40 years (n = 51 cycles); group 2: negative leiomyomata, age <40 years (n = 57 cycles); group 3: positive leiomyomata, age ≥40 years (n = 22 cycles); group 4: negative leiomyomata, age ≥40 years (n = 59 cycles). A subgroup of all group 2 patients aged 35–39 (group 2A, n = 113 cycles) was also evaluated as an additional control. Intervention(s): Controlled ovarian hyperstimulation, IVF-ET. Main Outcome Measure(s): Implantation (IR), live birth (LBR) rates. Result(s): There were no significant differences in LBR among age-matched controls: group 1 (49%) versus 2 (57.5%) or 2A (57%) and group 3 (40.9%) versus 4 (32.2%). IR was significantly lower in group 1 (21.4%) versus 2 (33.3%) or 2A (33.9%) but not in group 3 (17.5%) versus 4 (11.6%). Implantation did not correlate with either mean leiomyoma diameter or volume. Conclusion(s): [1] LBR was not affected by the presence of intramural leiomyoma in IVF-ET patients with hysteroscopically normal endometrial cavities. [2] A significant decrease in IR was only noted in patients <40 years old. [3] Given the relatively high LBR in all groups, prophylactic surgical intervention cannot be justified, but precycle hysteroscopy evaluation is recommended.