Prognostic value of the location of submucosal uterine leiomyomas in infertility

Roșu,George-Alexandru; Ionescu,Crîngu Antoniu; Călin,Florin Daniel; Dimitriu,Mihai; Pleș,Liana; Matei,Alexandra; Navolan,Dan-Bogdan

doi:10.3892/etm.2021.10917

Prognostic value of the location of submucosal uterine leiomyomas in infertility

Authors:
- George-Alexandru Roșu
- Crîngu Antoniu Ionescu
- Florin Daniel Călin
- Mihai Dimitriu
- Liana Pleș
- Alexandra Matei
- Dan-Bogdan Navolan
View Affiliations

Affiliations: Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania, Department of Obstetrics and Gynecology, ‘Victor Babes’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
Published online on: October 25, 2021 https://doi.org/10.3892/etm.2021.10917
Article Number: 1482

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Submucosal fibroid location and size are predictive factors of impaired fertility. Submucosal fibroids cause infertility through several mechanisms including distortion of the endometrial cavity, increased uterine contractility, local inflammation and remodeling of the endometrial blood supply. This is a monocentric, retrospective, cross‑sectional study, conducted in the Department of Obstetrics and Gynecology of ‘Sf. Pantelimon’ Clinical Emergency Hospital, analyzing patients from a 5‑year period (January 2015‑December 2019). In the present study, the relationship between different characteristics of the submucosal fibroids (among others, location and dimensions) and fertility (birth rates, early pregnancy loss rates) were investigated. This study identified that submucosal and intramural fibroids are risk factors for reduced birth rate compared with subserosal fibroids (P=0.02, RR=2.58, 95% CI 1.03‑6.47; P=0.005, RR=1.18, 95% CI 1.02‑1.35, respectively). In addition, G2 leiomyomas are risk factors for low birth rate compared with G0 and G1 fibroids (P=0.01, RR=1.95, 95% CI 1.05‑3.60). Moreover, the presence of a subserosal fibroid was associated with an increased early pregnancy loss rate (P=0.01, RR=2.14, 95% CI 1.05‑4.35). In conclusion, the location and degree of uterine cavity distortion are important factors that alter the normal development of a pregnancy and the birth rate.

View Figures

View References

1	Ikhena DE and Bulun SE: Literature review on the role of uterine fibroids in endometrial function. Reprod Sci. 25:635–643. 2018.PubMed/NCBI View Article : Google Scholar
2	Levy G, Hill MJ, Beall S, Zarek SM, Segars JH and Catherino WH: Leiomyoma: Genetics, assisted reproduction, pregnancy and therapeutic advances. J Assist Reprod Genet. 29:703–712. 2012.PubMed/NCBI View Article : Google Scholar
3	Pritts EA, Parker WH and Olive DL: Fibroids and infertility: An updated systematic review of the evidence. Fertil Steril. 91:1215–1223. 2009.PubMed/NCBI View Article : Google Scholar
4	Gambadauro P: Dealing with uterine fibroids in reproductive medicine. J Obstet Gynaecol. 32:210–216. 2012.PubMed/NCBI View Article : Google Scholar
5	Brady PC, Stanic AK and Styer AK: Uterine fibroids and subfertility: An update on the role of myomectomy. Curr Opin Obstet Gynecol. 25:255–259. 2013.PubMed/NCBI View Article : Google Scholar
6	Carranza-Mamane B, Havelock J and Hemmings R: Reproductive Endocrinology and Infertility Committee; Special Contributor:The management of uterine fibroids in women with otherwise unexplained infertility. J Obstet Gynaecol Can. 37:277–285. 2015.PubMed/NCBI View Article : Google Scholar
7	Zepiridis LI, Grimbizis GF and Tarlatzis BC: Infertility and uterine fibroids. Best Pract Res Clin Obstet Gynaecol. 34:66–73. 2016.PubMed/NCBI View Article : Google Scholar
8	Christopoulos G, Vlismas A, Salim R, Islam R, Trew G and Lavery S: Fibroids that do not distort the uterine cavity and IVF success rates: An observational study using extensive matching criteria. BJOG. 124:615–621. 2017.PubMed/NCBI View Article : Google Scholar
9	Styer AK, Jin S, Liu D, Wang B, Polotsky AJ, Christianson MS, Vitek W, Engmann L, Hansen K, Wild R, et al: Association of uterine fibroids and pregnancy outcomes after ovarian stimulation- intrauterine insemination for unexplained infertility. Fertil Steril. 107:756–762.e3. 2017.PubMed/NCBI View Article : Google Scholar
10	Sarıdoğan E and Sarıdoğan E: Management of fibroids prior to in vitro fertilization/intracytoplasmic sperm injection: A pragmatic approach. J Turk Ger Gynecol Assoc. 20:55–59. 2019.PubMed/NCBI View Article : Google Scholar
11	Litta P, Conte L, De Marchi F, Saccardi C and Angioni S: Pregnancy outcome after hysteroscopic myomectomy. Gynecol Endocrinol. 30:149–152. 2014.PubMed/NCBI View Article : Google Scholar
12	Sagi-Dain L, Ojha K, Bider D, Levron J, Zinchenko V, Walster S, Sagi S and Dirnfeld M: Pregnancy outcomes in oocyte recipients with fibroids not impinging uterine cavity. Arch Gynecol Obstet. 295:497–502. 2017.PubMed/NCBI View Article : Google Scholar
13	Purohit P and Vigneswaran K: Fibroids and Infertility. Curr Obstet Gynecol Rep. 5:81–88. 2016.PubMed/NCBI View Article : Google Scholar
14	Unlu C, Celik O, Celik N and Otlu B: Expression of endometrial receptivity genes increase after myomectomy of intramural leiomyomas not distorting the endometrial cavity. Reprod Sci. 23:31–41. 2016.PubMed/NCBI View Article : Google Scholar
15	Rackow BW and Taylor HS: Submucosal uterine leiomyomas have a global effect on molecular determinants of endometrial receptivity. Fertil Steril. 93:2027–2034. 2010.PubMed/NCBI View Article : Google Scholar
16	Ben-Nagi J, Miell J, Mavrelos D, Naftalin J, Lee C and Jurkovic D: Endometrial implantation factors in women with submucous uterine fibroids. Reprod Biomed Online. 21:610–615. 2010.PubMed/NCBI View Article : Google Scholar
17	Demir M, Kalyoncu S, Ince O, Ozkan B, Kelekci S, Saglam G, Sutcu R and Yilmaz B: Endometrial flushing tumor necrosis factor alpha and interleukin 2 levels in women with polycystic ovary syndrome, leiomyoma and endometrioma: Comparison with healthy controls. Geburtshilfe Frauenheilkd. 79:517–523. 2019.PubMed/NCBI View Article : Google Scholar
18	Sevostyanova O, Lisovskaya T, Chistyakova G, Kiseleva M, Sevostyanova N, Remizova I and Buev Y: Proinflammatory mediators and reproductive failure in women with uterine fibroids. Gynecol Endocrinol. 36:33–35. 2020.PubMed/NCBI View Article : Google Scholar
19	Doherty LF and Taylor HS: Leiomyoma-derived transforming growth factor-β impairs bone morphogenetic protein-2-mediated endometrial receptivity. Fertil Steril. 103:845–852. 2015.PubMed/NCBI View Article : Google Scholar
20	Ciarmela P, Islam MS, Reis FM, Gray PC, Bloise E, Petraglia F, Vale W and Castellucci M: Growth factors and myometrium: Biological effects in uterine fibroid and possible clinical implications. Hum Reprod Update. 17:772–790. 2011.PubMed/NCBI View Article : Google Scholar
21	Călin F, Ionescu C, Dimitriu M, Ciobanu AM, Badiu CD, Neacşu A, Socea B and Hudiţă D: The impact of uterine fibromatosis on the endometrium and fertility. J Surg Sci: Sept 2020. doi: 10.33695/jss.v7i2.350.
22	Matei A, Ionescu C, Gorun F, Gheorghiu D, Rosu GA, Dan A, Sima RM, Furau CG, Ilinca C and Navolan D: Insights on hysteroscopic procedures and their place in Romanian gynecologic practice- the experience of two medical units. Diagnostics (Basel). 10(281)2020.PubMed/NCBI View Article : Google Scholar
23	Bittencourt CA, Dos Santos Simões R, Bernardo WM, Fuchs LFP, Soares Júnior JM, Pastore AR and Baracat EC: Accuracy of saline contrast sonohysterography in detection of endometrial polyps and submucosal leiomyomas in women of reproductive age with abnormal uterine bleeding: Systematic review and meta-analysis. Ultrasound Obstet Gynecol. 50:32–39. 2017.PubMed/NCBI View Article : Google Scholar