Intramural myomas–related infertility: should the myomas be removed? Not easy to reach a consensus
VOLUME 116, ISSUE 4, P943-944
Jacques Donnez, M.D., Ph.D.
Several fibroids are asymptomatic, but in 30%–40% of cases, they show a variety of symptoms, depending on their location and size. They are increasingly observed in women requiring a medical opinion for infertility for two reasons: longer reproductive timeline in women thanks to improvements in medical care and current trend for women to postpone childbearing. Since publication of the review by Pritts et al. (1) and the clear message that women with submucosal myomas experience significantly lower implantation, clinical pregnancy, ongoing pregnancy, and live birth rates, as well as significantly higher miscarriage rates, the need to treat submucosal fibroids is widely accepted. However, the effect of non-cavity-distorting uterine fibroids is still an ongoing debate, and fibroids in other locations (types 3, 4, 5, 6, 2–5 according to the International Federation of Gynecology and Obstetrics classification) (2) continue to present a clinical conundrum.