- Leili Safdarian
- - Department of Obstet . and Gynecol Shariati Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Reyhaneh Pirjani
- - Department of Obstet . and Gynecol Shariati Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Abbas Rahimi Foroushani
- - Epidemiology Department, Faculty of Publi Health, Tehran Medical Sciences University, Tehran, Iran
- Kazem Mohammad
- - Epidemiology Department, Faculty of Publi Health, Tehran Medical Sciences University, Tehran, Iran
- Hojjatallah Saeidi Saeidabady
- 1- Medical Biochmistry Department, Faculty of Medicine, Tehran Medical Sciences University, Tehran, Iran
- 2- Department of Obstet . and Gynecol ,Shariati Hospital, Tehran Medical Sciences University, Tehran, Iran
Received: 4/1/2004 Accepted: 4/1/2004 - Publisher : Avicenna Research Institute |
|
Related Articles |
|
Other Format |
|
|
|
Abstract
Introduction: Surveys indicate that 10-15% of couples in reproductive ages are infertile. Fur-thermore, 20% of women will develop a fibroid during their reproductive life. Fibroid is infer-quently considered as a sole primary etiology of infertility. However, Considering the signify-cance of infertility in gynecology and the prevalence of uterine fibroids in reproductive age, as well as the discrepancies in the results of different studies regarding the impact of fibroids on fertility, accurate management of fibroids in infertile cases deserves greater Consideration. Considering the disagreements in this background, the present study was designed to study the effects of uterine fibroids on implantation and abortion in assisted reproductive techniques. Materials and Methods: In our cohort study 120 and 240 ART cycles in infertile patients with & without fibroma, respectively, admitted to Shariati Hospital in 2001-2003, were assessed for the effects of fibroids on implantation and abortion by using logistic regression analysis for confounding variables. Results: Successful Implantation in patients with and without fibroma was 16.7% and 28.7% respectively, with a statistically significant difference (P=0.014, OR=1.72, CI=1.1– 2.7). This relation was more prominent after logistic regression analysis for confounding variables, raising the adjusted OR from 1.72 to 2.17. Implantation rate, in less than 3 cm fibroma was more than 3.1 - 5 cm fibroma. Abortion rates in patients with and without fibroma were 71.4% & 34.9% respectively, that indicates abortion rate is significantly higher in the presence of fibroids even after elimination of other factors (P=0.024). Conclusion: In this study the negative effect of fibroma on implantation and increasing rate of abortion were obtained by logistic regression analysis, however, further clinical trials are essential to verify the competence of operative resection of different size fibroids to improve the outcome of ART.
Keywords:
Infertility, Fibroma, Implantation, Abortion, Leiomyoma, Cohort study, Assisted Reproductive Techniques To cite this article:References
- Speroff L. Clinical Gynecology Endocrinology & Infertility. 6th Edition, Baltimore, Lippincott Williams & Wilkins.1999;pp:149-152.
- Berek J.S. Novak’s Gynecology. 13th Edition, Philadelphia: Lippincott Williams & wilkins. 2002;pp:380-387.
- Ramzj A.M., Sattar M., Amin Y., et al. Uterine myomata and outcome of assisted reproduction. Hum Reprod.1998;13(1):198-202.
- Yarali H., Bukulmez D. The effect of intra-mural and Subserous uterine fibroid, on implanta-tion and clinical pregnancy rate in patients having intracytoplasmic sperm injection. Arch Gynecol Obstet.2002; 266(1):30–3.
- Jun S.H., Ginsburg E.S., Recowsky C., et al. Uterine leiomyomas and their effect on in vitro fertilization outcome: a retrospective study. J Assisted Reprod Genet.2001;18(3):139-143.
- Bajekal N., Li T.C. Fibroids, infertility & preg-nancy wastage. Hum Reprod Update.2000;6(6): 614-20.
- Hart R., khalaf J., Yeag C.T., et al. A pros-pective controlled study of the effect of intera-mural uterine fibroids on the outcome of ART. Hum Reprod.2001;16(11):2411-7.
- Eldar Geva T., Meagher S., Healy D.L., et al. Effect of interamural, subserosal & submucosal uterine fibroids on the outcome of Assisted Reproductive Technology treatment. Fertil Steril.1998;70(4):687-691.
- Stovall D.W., Pansh S.D., Van Voorhis S., et al. Uterine leiomyomas reduce the efficacy of assisted reproduction cycles: Results of a matched follow up study. Hum Reprod.1998;13(1): 192-197.
- Check J.H., Choe J.K., Lee G., Dietterich C. The effect on IVF outcome of small intramural fibroids not compressing the uterine cavity as determined by aprospective matched control study. Hum Reprod.2002; 17(5):1244-1248.
- Schahman G.L., Navarro Pardo J.M. Fibroids and in vitro fertilization. Reprod Med North AM. 2003;13(2)-341-351.
- Eric S., Surrey S., Lietz A.K., Schoolcraft W.B. Impact of intramural leiomyomata in patients with a normal endometrial cavity on IVF cycle outcome. Fertil Steril.2001;75(2):405-410.
- Bultum V.C., Reiter R.C. Uterine leiomyom- ata: etiology symptomatology and management. Fertil Steril.1981;36:433-445.
- Seond M.A., Pallerson R., Muashar S.J. Effect of myoma or prior myomectomy on IVF perform-ance. J Assist Reprod Genet.1992;9(3):217-20.
- Check J.H., Choe J.K., Lee G., et al. The effect on IVF outcome of small intramural fibroids not compressing the uterine cavity as determined by a prospective matched control study. Hum Reprod.2002;17(5):1244-8.
- Gardner D., Weissman A., Mhowles C. Text Book of Assisted Reproductive Techniques. Mar-tin Dunitz.2001;pp:401.
- Leone F.P.G., Lanzani Ch., Ferrazzi E. Use of strict sonohysterographic methods for preopera-tive assessment of submucous myomas. Fertil Steril. 2003;79(4):988-1002.