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Hum. Reprod. Advance Access published online on November 12, 2009
Human Reproduction, doi:10.1093/humrep/dep396
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© The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

The effect of intramural fibroids without uterine cavity involvement on the outcome of IVF treatment: a systematic review and meta-analysis

Sesh Kamal Sunkara1, Mohammed Khairy, Tarek El-Toukhy, Yacoub Khalaf and Arri Coomarasamy

Assisted Conception Unit, Guy's and St Thomas' Hospitals NHS Foundation Trust, 11th Floor, Tower Wing Guy's Hospital Great Maze Pond, London SE1 9RT, UK

1 Correspondence address. E-mail: sksunkara{at}hotmail.com

BACKGROUND: The influence of fibroids on fertility is poorly understood. Submucosal and intramural fibroids that distort the endometrial cavity have been associated with decreased pregnancy rates (PRs) following IVF treatment. However, there is uncertainty about the effect of intramural fibroids that do not distort the endometrial cavity on IVF outcomes.

METHODS: We conducted a systematic review and meta-analysis of studies to evaluate the association between non-cavity-distorting intramural fibroids and IVF outcome. Searches were conducted on MEDLINE, EMBASE, Cochrane Library and Web of Science. Study selection and data extraction were conducted independently by two reviewers. The Newcastle-Ottawa Quality Assessment Scales were used for quality assessment. Meta-analysis was performed if appropriate.

RESULTS: We identified 19 observational studies comprising 6087 IVF cycles. Meta-analysis of these studies showed a significant decrease in the live birth (RR = 0.79, 95% CI: 0.70–0.88, P < 0.0001) and clinical PRs (RR = 0.85, 95% CI: 0.77–0.94, P = 0.002) in women with non-cavity-distorting intramural fibroids compared with those without fibroids, following IVF treatment.

CONCLUSION: The presence of non-cavity-distorting intramural fibroids is associated with adverse pregnancy outcomes in women undergoing IVF treatment.

Key words: intramural fibroids/IVF/pregnancy/observational studies

Submitted on March 5, 2009; resubmitted on September 8, 2009; accepted on October 14, 2009.


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