Should we operate on fibroids before IVF

The effect of uterine leiomyoma on fertility is subject to continuous debate. IVF provides a unique opportunity to examine the effect of leiomyoma on embryonic implantation rate. Over the last two decades, many studies were published associating fibroids and infertility. Taken together these publications indicate that the implantation rate and pregnancy outcome is impaired in women with uterine leiomyoma when they cause deformation of the uterine cavity. In such patients, surgical treatment should be considered prior to IVF because of the reduced implantation rate, however, there are few prospective controlled studies that test the hypothesis that myomectomy with its inherent risks can help. In patients with intramural leiomyoma not invading the uterine cavity, the confusion still persists. Furthermore, even if one accepts that a negative effect of such fibroids exists, there is no direct proof that myomectomy results offer a better prognosis.