Uterine fibroids: relationships to reproduction

The purpose of this review is to summarize the available evidence on the effects of uterine fibroids on fertility, infertility and pregnancy outcomes, and the effects of parity on fibroids. Fibroids, found in approximately 4% of pregnant women, are associated with an increased risk of pregnancy complications. However, prophylactic myomectomy in asymptomatic women is not only unjustified, but it may have adverse effects on reproduction. Fibroids are found in 1% to 2.4% of women with unexplained infertility. Removal of fibroids that distort the uterine cavity may be beneficial in infertile women with unexplained infertility and in women undergoing in vitro fertilization. The pregnancy rate after hysteroscopic, laparoscopic or abdominal myomectomy appears to be the same. Laparoscopic myolysis appears to have adverse effects on pregnancy outcomes while uterine artery occlusion in infertile and fertile women requires urgent prospective evaluation. Parity appears to be a natural global killer of uterine fibroids, most likely, through transient uterine ischemia, similar to that of uterine artery occlusion.