Hum. Reprod. Advance Access originally published online on June 21, 2006
Human Reproduction 2006 21(10):2640-2644; doi:10.1093/humrep/del218
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The effect of small intramural uterine fibroids on the cumulative outcome of assisted conception
1 Assisted Conception Unit, Guy’s and St. Thomas’ Hospital NHS Foundation Trust 2 Department of Women’s Health, King’s College London, UK 3 Department of Obstetrics and Gynecology, School of Women’s and Infants’ Health, University of Western Australia and 4 Division of Reproductive Health, Endocrinology and Development, King’s College London, UK
5 To whom correspondence should be addressed at: Assisted Conception Unit, 4th Floor Thomas Guy House, Guy’s Hospital, St. Thomas Street, London SE1 9RT, UK. E-mail: yakoub.khalaf{at}kcl.ac.uk
BACKGROUND: This study aimed to evaluate the effect of small intramural fibroids on the cumulative pregnancy, ongoing pregnancy, live birth and implantation rates after three IVF/ICSI attempts. METHODS: The first three treatment cycles of women enrolled for IVF/ICSI over a 12-month period were analysed. Only patients with small (
5 cm) intramural fibroids not encroaching upon the endometrial cavity were included in the fibroid group. Cox’s hazards regression was used to estimate the hazard ratio (HR) associated with the presence of intramural fibroids. RESULTS: During the study period, 322 women without fibroids (control group) and 112 women with fibroids (study group) underwent 606 IVF/ICSI cycles. The pregnancy, ongoing pregnancy and live birth rates in the study group were 23.6, 18.8 and 14.8% compared with 32.9, 28.5 and 24% in the control group, respectively (P < 0.05). Cox regression analysis showed that the pregnancy rate at each cycle was reduced by 39% (HR = 0.61, 95% CI = 0.39–0.95, P = 0.029) in the study group compared with the control group. The cumulative ongoing pregnancy rate was reduced by 43% (HR = 0.57, 95% CI = 0.35–0.91, P = 0.018), and the cumulative live birth rate was reduced by 47% (HR = 0.53, 95% CI = 0.32–0.87, P = 0.013) in the study group. After adjusting for confounding variables, the presence of fibroids was found to significantly reduce the ongoing pregnancy rate at each cycle of IVF/ICSI by 40% (HR = 0.60, 95% CI = 0.36–0.99, P = 0.048) and the live birth rate at each cycle by 45% (HR = 0.55, 95% CI = 0.32–0.95, P = 0.03). CONCLUSION: Small intramural fibroids are associated with a significant reduction in the cumulative pregnancy, ongoing pregnancy and live birth rates after three IVF/ICSI cycles.
Key words: ART/fibroids/hazard regression analysis/live birth/pregnancy
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  E. Somigliana, P. Vercellini, R. Daguati, R. Pasin, O. De Giorgi, and P.G. Crosignani Fibroids and female reproduction: a critical analysis of the evidence Hum. Reprod. Update, September 1, 2007; 13(5): 465 - 476. [Abstract] [Full Text] [PDF]
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