Uterine fibroids
Authors:   , Don Emma Emmily 
Published: November 2023

The thesis explores the impact of uterine fibroids on infertility and reproductive outcomes, as well as the pathophysiology of fibroids and the effectiveness of myomectomy in treating related symptoms and improving reproductive outcomes. It is divided into three sections.

In Part I, the study investigates how fibroid treatment, specifically myomectomy, affects infertility and fibroid-related symptoms. Uterine fibroids, benign tumors in the uterine wall, can cause symptoms like heavy menstrual bleeding, pelvic pain, and infertility. The research, known as the MyoFert study, examined the effect of myomectomy on live birth rates and other reproductive outcomes. The results showed that myomectomy did not significantly increase the time to live birth compared to expectant management, despite patients who had myomectomy having larger and more symptomatic fibroids. However, myomectomy led to substantial improvements in fibroid-related symptoms and quality of life, emphasizing its benefits.

In Part II, the focus shifts to fibroid-related issues during pregnancy, particularly the risk of preterm birth. A systematic review and meta-analysis of 11 observational studies revealed that women with fibroids had a higher incidence of preterm birth compared to those without fibroids, with a more pronounced risk at earlier gestational ages. The presence of fibroid necrosis during pregnancy was also linked to (imminent) preterm birth. The study highlights the need for further research to clarify this association and emphasizes the importance of identifying fibroid-related complications during pregnancy.

Part III delves into the pathophysiology of fibroids and their role in infertility and obstetric complications. The study proposes several hypotheses, such as fibroids contributing to sexual dysfunction, mechanical interference with oocyte and sperm transport, disruption of peristalsis in the uterine wall, changes in the uterine microbiome, and more. The data regarding the link between fibroids and miscarriage is inconclusive, calling for larger studies. The study emphasizes the importance of understanding the pathogenic mechanisms behind fibroid-related infertility and the need for systematic assessment of fibroids in various clinical scenarios.

In the final chapter, the thesis provides an overview of complications related to fibroids during and after pregnancy and continues the discussion on the effects of myomectomy on symptoms, infertility, and reproductive outcomes. Future research directions are also outlined.

In summary, the thesis highlights the complex relationship between uterine fibroids, infertility, and reproductive outcomes. Myomectomy appears to offer symptom relief but may not significantly increase live birth rates. Fibroids are associated with a higher risk of preterm birth, especially in cases of fibroid necrosis during pregnancy. The pathophysiology of fibroids in infertility and obstetric complications is multifaceted, with various hypotheses proposed. Understanding these mechanisms is crucial for improving treatment and care for women with fibroids. The thesis emphasizes the importance of systematic assessment and the need for further research in this field.