August 2024 - Volume 144 - Issue 2
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Reviews: Systematic Review

Intramural Leiomyomas and Fertility
A Systematic Review and Meta-Analysis
Pritts, Taïna Laurore; Ogden, Meghan MD; Parker, William MD; Ratcliffe, Jennifer MD; Pritts,Elizabeth A. MD
Author Information
University of Wisconsin and the Wisconsin Fertility Institute, Madison, Wisconsin; and theUniversity of California, San Diego, San Diego, and Advanced Fertility Associates Medical Group,Santa Rosa, California.
Corresponding author: Elizabeth A. Pritts, MD, Wisconsin Fertility Institute, Madison, WI;
prittselizabeth@gmail.com.

Financial Disclosure Elizabeth A. Pritts is a scientific advisor for Claria, an instrument company
that makes morcellators for use during pelvic surgery. The other authors did not report any
potential conflicts of interest.
Presented at the AAGL 52nd Global Congress on MIGS, November 5–8, 2023, Nashville,Tennessee.
Each author has confirmed compliance with the journal's requirements for authorship.
Peer reviews and author correspondence are available at https://links.lww.com/AOG/D730.
Obstetrics & Gynecology 144(2):p 171-179, August 2024. | DOI: 10.1097/AOG.0000000000005661
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Abstract

In Brief

OBJECTIVE:
To evaluate fertility outcomes based on size and number of intramural leiomyomas and outcomes
after removal.

DATA SOURCES:
Online searches: MEDLINE, ClinicalTrials.gov, PubMed, Cochrane Library, and PROSPERO
Library from 1994 to 2023.

METHODS OF STUDY SELECTION:
A total of 5,143 studies were identified, with inclusion of 13 study groups.

TABULATION, INTEGRATION AND RESULTS:Outcomes for size and number of leiomyomas were reported with clinical pregnancy rates andongoing pregnancy or live-birth rates. In data sets with maximum leiomyoma diameters of lessthan 6 cm for study inclusion, women with leiomyomas smaller than 3 cm had lower clinicalpregnancy rates than women without leiomyomas, with an odds ratio (OR) of 0.53 (95% CI, 0.38–0.76) and, for ongoing pregnancy or live-birth rates, an OR of 0.59 (95% CI, 0.41–0.86). The ORs
for clinical pregnancy rates in women with intermediately-sized leiomyomas (those between 3 cm
and 6 cm) were lower than in women without leiomyomas, with an OR at 0.43 (95% CI, 0.29–0.63)
and, for ongoing pregnancy or live-birth rates, an OR at 0.38 (95% CI, 0.24–0.59). In data sets
without exclusion for women with larger-sized leiomyomas, clinical pregnancy rates were lower for
those with leiomyomas smaller than 5 cm compared with those without leiomyomas, with an OR of
0.75 (95% CI, 0.58–0.96). Women with leiomyomas larger than 5 cm showed no differences inclinical pregnancy rate compared with women without leiomyomas, with an OR of 0.71 (95% CI,0.32–1.58). Although women with a single leiomyoma in any location had no differences inoutcomes, those with more than one leiomyoma had lower clinical pregnancy rates and ongoing
pregnancy or live-birth rates, with an OR of 0.62 (95% CI, 0.44–0.86) and 0.57 (95% CI, 0.36–0.88), respectively. The clinical pregnancy rate for women undergoing myomectomy for intramuralleiomyomas was no different than those with intramural leiomyomas in situ, with an OR of 1.10(95% CI, 0.77–1.59).

CONCLUSION:

Even small intramural leiomyomas are associated with lower fertility; removal does not confer
benefit. Women with more than one leiomyoma in any location have reduced fertility.
© 2024 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer
Health, Inc. All rights reserved.

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