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Evidence summaries

Surgical Treatment of Fibroids for Subfertility

Myomectomy may be effective for increasing the clinical pregnancy rate in women with unexplained subfertility and submucous fibroids compared with expectant management. Level of evidence: "C"

Comment: The quality of evidence is downgraded by imprecise results (few outcome events) and by potential reporting bias (only few small studies).

Summary

A Cochrane review [Abstract] 1 included 2 studies with a total of 298 subjects. In women with otherwise unexplained subfertility and submucous fibroids, there is was a trend for benefit with hysteroscopic myomectomy compared to regular fertility-oriented intercourse during 12 months for clinical pregnancy (39% vs 21%; OR 2.4, 95% CI 0.97 to 6.2, n=94). The hysteroscopic removal of polyps prior to intrauterine insemination increases the odds of clinical pregnancy compared to diagnostic hysteroscopy and polyp biopsy only ( 63% vs 28%, OR 4.4, 95% CI 2.5 to 8.0; n=204).

Another Cochrane review [Abstract] 2 included 4 studies with a total of 442 subjects. One study examined the effect of myomectomy on reproductive outcomes and showed no clear evidence on the clinical pregnancy rate for intramural (OR 1.88, 95% CI 0.57 to 6.14), submucous (OR 2.04, 95% CI 0.62 to 6.66), combined intramural and subserous (OR 2.00, 95% CI 0.40 to 10.09) and combined intramural submucous fibroids (OR 3.24, 95% CI 0.72 to 14.57). In comparison of open versus laparoscopic myomectomy no evidence for a significant effect on the live birth rate was found in 2 trials (OR 0.80, 95% CI 0.42 to 1.5; n=177), clinical pregnancy rate (OR 0.96, 95% CI 0.52 to 1.78; n=177), miscarriage rate, preterm labour rate, and caesarean section rate.

Note

Date of latest search: 2020-03-07

    References

    • Bosteels J, van Wessel S, Weyers S et al. Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities. Cochrane Database Syst Rev 2018;12():CD009461. [PubMed]
    • Metwally M, Raybould G, Cheong YC et al. Surgical treatment of fibroids for subfertility. Cochrane Database Syst Rev 2020;(1):CD003857. [PubMed]

Primary/Secondary Keywords