An Observational Study of Treatment Outcomes of Uterine Myoma among Clients who had Undergone Invitro Fertilization at a Public Center in Addis Ababa, Ethiopia
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Abstract
Background: - For clients undergoing invitro-fertilization(IVF) there is no consensus regarding the management of non-cavity distorting Intramural myoma
Objective: To assess the prevalence and treatment outcomes of IVF clients with uterine myoma.
Methods: A 2-year (April 1 2019-April 1,2021) chart review was conducted for 1300 infertile women who had undergone IVF. Categorical data were summarized in proportion, and continuous data were summarized using mean, median, and standard deviation where appropriate. Bivariate logistic regression was conducted to assess the association between predictor variables and the outcome variable (clinical pregnancy). P-Value < 0.05 was taken to be significant
Results: Of the total 1,300 IVF clients, 282 (21.7%) cases were diagnosed to have myoma. Among the 13 cases of cavity distorting intramural myoma who underwent IVF without myomectomy, all were negative for clinical pregnancy, whereas among the 60 cases of cavity distorting myoma who had pre-IVF myomectomy followed by IVF, 16 (26.7%) were positive for clinical pregnancy. This difference was not statistically significant (P=0.160).
Among 138 cases of non-cavity distorting Intramural Myoma who had undergone IVF without pre-IVF myomectomy, 38 (27.5%) had clinical pregnancy. In contrast, among 19 cases who had undergone pre-IVF myomectomy followed by IVF, only 2 (10.5%) had a clinical pregnancy. This difference was not statistically significant (P=0.160).
Conclusion: While not statistically significant, conducting pre-IVF myomectomy for cavity distorting myomas improves clinical pregnancy, while pre-IVF Myomectomy does not improve clinical pregnancy for women with non-cavity distorting myoma. we recommend further research with a larger sample size
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myoma; infertility;invitro fertilization; myomectomy; treatment outcomes
2. Barbara L.Hoffman MJOS, MD Joseph l.Schafer, MD Lisa M.Halvorson,MD Karen D.Bradshaw,MD F.Garry Cunningham,MD. Williams Gynecology 2012;2nd edition.
3. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100-7.
4. Cramer SF, Patel A. The Frequency of Uterine Leiomyomas. American journal of clinical pathology. 1990;94(4):435-8.
5. Donnez J, Jadoul P. What are the implications of myomas on fertility? Human Reproduction. 2002;17(6):1424-30.
6. Myomas and reproductive function. Fertil Steril. 2008;90(5 Suppl):S125-30.
7. Ezzati M, Norian JM, Segars JH. Management of Uterine Fibroids in the Patient Pursuing Assisted Reproductive Technologies. Women's Health. 2009;5(4):413-21.
8. Benecke C, Kruger TF, Siebert TI, Van der Merwe JP, Steyn DW. Effect of fibroids on fertility in patients undergoing assisted reproduction. A structured literature review. Gynecologic and obstetric investigation. 2005;59(4):225-30.
9. Somigliana E, Vercellini P, Daguati R, Pasin R, De Giorgi O, Crosignani PG. Fibroids and female reproduction: a critical analysis of the evidence. Human Reproduction Update. 2007;13(5):465-76.
10. Klatsky PC, Tran ND, Caughey AB, Fujimoto VY. Fibroids and reproductive outcomes: a systematic literature review from conception to delivery. American Journal of Obstetrics and Gynecology. 2008;198(4):357-66.
11. Pritts EA, Parker WH, Olive DL. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril. 2009;91(4):1215-23.
12. Hartmann KE, Velez Edwards DR, Savitz DA, Jonsson-Funk ML, Wu P, Sundermann AC, et al. Prospective Cohort Study of Uterine Fibroids and Miscarriage Risk. American Journal of Epidemiology. 2017;186(10):1140-8.
13. Eldar-Geva T, Meagher S, Healy DL, MacLachlan V, Breheny S, Wood C. Effect of intramural, subserosal, and submucosal uterine fibroids on the outcome of assisted reproductive technology treatment. Fertil Steril. 1998;70(4):687-91.
14. Stovall DW, Parrish SB, Van Voorhis BJ, Hahn SJ, Sparks AE, Syrop CH. Uterine leiomyomas reduce the efficacy of assisted reproduction cycles: results of a matched follow-up study. Human Reproduction. 1998;13(1):192-7.
15. Hart R, Khalaf Y, Yeong C-T, Seed P, Taylor A, Braude P. A prospective controlled study of the effect of intramural uterine fibroids on the outcome of assisted conception. Human Reproduction. 2001;16(11):2411-7.
16. Khalaf Y, Ross C, El-Toukhy T, Hart R, Seed P, Braude P. The effect of small intramural uterine fibroids on the cumulative outcome of assisted conception. Human Reproduction. 2006;21(10):2640-4.
17. Healy DL. Impact of Uterine Fibroids on ART Outcome. Environmental Health Perspectives. 2000;108:845.
18. Farhi J, Ashkenazi J, Feldberg D, Dicker D, Orvieto R, Ben Rafael Z. Effect of uterine leiomyomata on the results of in-vitro fertilization treatment. Human Reproduction. 1995;10(10):2576-8.
19. Dietterich C, Check JH, Choe JK, Nazari A, Fox F. The presence of small uterine fibroids not distorting the endometrial cavity does not adversely affect conception outcome following embryo transfer in older recipients. Clinical and experimental obstetrics & gynecology. 2000;27(3-4):168-70.
20. Jun SH, Ginsburg ES, Racowsky C, Wise LA, Hornstein MD. Journal of Assisted Reproduction and Genetics. 2001;18(3):139-43.
21. Surrey ES, Lietz AK, Schoolcraft WB. Impact of intramural leiomyomata in patients with a normal endometrial cavity on in vitro fertilization–embryo transfer cycle outcome. Fertility and Sterility. 2001;75(2):405-10.
22. Check JH. The effect on IVF outcome of small intramural fibroids not compressing the uterine cavity as determined by a prospective matched control study. Human Reproduction. 2002;17(5):1244-8.
23. Oliveira FG, Abdelmassih VG, Diamond MP, Dozortsev D, Melo NR, Abdelmassih R. Impact of subserosal and intramural uterine fibroids that do not distort the endometrial cavity on the outcome of in vitro fertilization–intracytoplasmic sperm injection. Fertility and Sterility. 2004;81(3):582-7.
