Is another meta-analysis on the effects of intramural fibroids on reproductive outcomes needed?

Intramural fibroids when encountered in women undergoing fertility treatment present a clinical dilemma. Despite recent studies that have suggested a negative outcome for intramural fibroids on fertility outcomes, the evidence remains far from conclusive. The current study presents a systematic review and meta-analysis of the currently available evidence. Relevant articles were identified in MEDLINE and EMBASE. Ten studies reported the effects of intramural fibroids on assisted conception treatment including one study reporting the effect of myomectomy for these fibroids. Combined analysis of the included studies, after taking into account possible confounding factors, showed no evidence of a significant effect for intramural fibroids on clinical pregnancy rate (odds ratio (OR) 0.74, 95% confidence intervals (CI) 0.50-1.09), live birth rate (OR 1.17, 95% CI 0.62-2.22) or miscarriage rate (OR 1.61, 95% CI 0.61-4.20). There was also no evidence for a significant effect for myomectomy on the clinical pregnancy rate (OR 1.88, 95% CI 0.57-6.14) or the miscarriage rate (OR 0.89, 95% CI 0.14-5.48). These findings highlight the current deficiency in the literature and suggest that evidence is insufficient to draw any conclusions regarding the effect of intramural fibroids on reproductive outcomes.