IVF: Should Fibroids Be Removed First?

I have multiple intramural fibroids and require in vitro fertilization because of a previous tubal ligation that cannot be repaired. My fibroids are four and five centimeters in diameter. Should I have them removed prior to my IVF attempt?

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An open discussion with your reproductive endocrinologist regarding the literature available on fibroids and ART will help you decide whether a myomectomy is indicated in your case. Recent data suggests that if the fibroids are greater than approximately two-and-a-half centimeters, consideration should be given to a myomectomy.

A recent study in women with fibroids undergoing ART, performed at Monash University in Australia, compared 88 infertile women with fibroids diagnosed by transvaginal sonography. These women underwent IVF, GIFT or IVF with ICSI and were compared with age-matched, diagnosis matched controls. The fibroid group was broken down into women with only subserosal fibroids (38 percent), intramural with or without subserosal fibroids without cavity distortion (52 percent), and 10 percent with submucosal, cavity distortion. The fibroids were for the most part between two-and-a-half and four-and-a-half centimeters in diameter. The pregnancy rates in the control group were 31 percent compared to 34 percent in the subserosal group, 16 percent in the intramural group, and 10 percent in the submucosal group. They also showed that if a pregnancy did occur in the intramural or submucosal group the miscarriage rates were higher.

These results suggest that despite the absence of distortion of the endometrial lining by the intramural fibroids they potentially may reduce overall pregnancy rates and increase the miscarriage rate in IVF patients.

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