Fibromas and Infertility. What is the Role of Myomectomy in the Improvement of Fertility?

Abstract

Introduction: Uterine fibroids, also known as myomas, are benign tumors that develop from the smooth muscle cells of the uterus. Fibroids are estimated to occur predominantly in 20% to 40% of women of reproductive age, in whom they can cause symptoms like pressure, discomfort and excessive hemorrhage.

Evidence acquisition: Precise assessment of fibroid size, number and location is crucial for selecting the appropriate treatment for the patient. Treatment options include medical management, interventional radiology and surgery, depending on the patient's symptoms and fertility desires.

Evidence synthesis: Gynecologists must create personalized plans based on fibroid characteristics and their potential impact on fertility. Hysteroscopic myomectomy has been shown to improve pregnancy rates in certain cases. However, myomectomy is not always recommended for asymptomatic women with fibroids that do not distort the uterine cavity. It may be considered when pelvic anatomy is significantly affected, because it hinders procedures like oocyte retrieval. The relationship between specific number, size and position of myomas (excluding submucosal myomas or intramural myomas that distort the endometrial cavity) with the outcomes of pregnancy has not been verified.

Conclusion: Considering the lack of current randomized controlled trials (RCTs) investigating the effects of myomectomy, it is advisable to conduct future multicenter prospective studies.