Removal Of Myomas In Asymptomatic Patients To Improve Fertility And/Or Reduce Miscarriage Rate
Publication Date: September 1, 2017
Last Updated: March 14, 2022
Summary
There is insufficient evidence to conclude that myomas reduce the likelihood of achieving pregnancy with or without fertility treatment. (, C)
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There is insufficient evidence to determine that a specific myoma size, number, or location (excluding submucosal myomas or intramural myomas impacting the endometrial cavity contour) is associated with a reduced likelihood of achieving pregnancy or an increased risk of early pregnancy loss. (, C)
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There is insufficient evidence that removal of subserosal fibroids improves fertility. (, C)
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There is fair evidence that myomectomy does not impair reproductive outcomes (clinical pregnancy rates, live-birth rates) following ART. (, B)
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There is insufficient evidence that myomectomy (laparoscopic or open) reduces miscarriage rates. (, C)
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There is fair evidence that hysteroscopic myomectomy for submucosal myomas improves clinical pregnancy rates. (, B)
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There is insufficient evidence to conclude that hysteroscopic myomectomy reduces the likelihood of early pregnancy loss in women with infertility and a submucous fibroid. (, C)
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Recommendations
In asymptomatic women with cavity-distorting myomas (intramural with a submucosal component or submucosal), myomectomy (open or laparoscopic or hysteroscopic) may be considered to improve pregnancy rates. (, )
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Myomectomy is generally not advised to improve pregnancy outcomes in asymptomatic infertile women with non-cavity‒distorting myomas. However, myomectomy may be reasonable in some circumstances, including but not limited to severe distortion of the pelvic architecture complicating access to the ovaries for oocyte retrieval. (, )
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Title
Removal Of Myomas In Asymptomatic Patients To Improve Fertility And/Or Reduce Miscarriage Rate
Authoring Organization
American Society for Reproductive Medicine
Publication Month/Year
September 1, 2017
Last Updated Month/Year
January 17, 2024
External Publication Status
Published
Country of Publication
US
Document Objectives
The purpose of this systematic review is to evaluate if uterine myomas impact the likelihood of pregnancy and pregnancy loss, and if myomectomy influences pregnancy outcomes in asymptomatic women.
Target Patient Population
Infertile patients with asymptomatic uterine myomas
Inclusion Criteria
Female, Adult
Health Care Settings
Ambulatory, Hospital, Operating and recovery room, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Management, Treatment
Diseases/Conditions (MeSH)
D011247 - Pregnancy, D007246 - Infertility, D007247 - Infertility, Female, D018873 - Pregnancy Rate, D063186 - Uterine Myomectomy
Keywords
pregnancy, infertility, myomas