Myoma Uteri

myomauteri-1-0-25kapak

Myoma and Infertility

Sabri Çolak1
İlknur Merve Ayazoğlu2

1Bahçeci Health Group, Bahçeci Bursa Assisted Reproduction Centre, Department of Gynecology and in Vitro Fertilizations, Bursa, Türkiye
2Recep Tayyip Erdoğan University, Faculty of Medicine, Department of Gynecology and Obstetrics, Rize, Türkiye

Çolak S, Ayazoğlu İM. Myoma and Infertility. Yavuz AF, ed. Myoma Uteri. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.139-152.

ABSTRACT

Uterine myomas are the most common pelvic neoplasms in women, mostly benign, arising from smooth muscle cells and fibroblasts. Their prevalence increases with age in the reproductive age group, and the association of myomata and infertility is expected to increase with advancing fertile age, which makes management studies important. Many factors are being examined in the management of the infertile couple and some theories have tried to explain the mechanisms of myomata on infertility. The idea that myomas may adversely affect fertility not only due to physical compression but also due to some immunologic and endocrine reasons has led to the development of different perspectives on its treatment. Although there are various recommendations in some international guidelines regarding the management of myomata in infertile women, there is no widely accepted algorithm. Because of the high rate of new myoma formation following uterine-sparing interventions such as myomectomy, myomata should be treated as close as possible to the active consideration of pregnancy. While hysteroscopic myomectomy seems to be the primary treatment for submucosal myomata, which have a proven effect on infertility, different recommendations have been presented throughout history regarding the management of intramural myomata, and recent studies have emphasized myoma excision. The method of myomectomy is also important, and a recent study showed that there was no significant difference in pregnancy rates between laparoscopic and laparotomic myomectomy, suggesting that the surgeon’s experience and equipment should be taken into consideration. The fact that many of the agents used in the medical treatment of myomata have contraceptive effects limits the use of medical treatment of myomas in infertile couples. Gonadotropin-releasing hormone (GnRH) antagonists are recommended for short-term benefit in the preoperative period, but further studies on their use as a single medical treatment agent are needed. As another medical agent, selective progesterone receptor modulators (SPRMs) are valuable because of their advantages over GnRH agonists, such as no adverse hypoestrogenic effects and no bone loss, but ulipristal acetate (UPA) has been associated with the risk of severe liver damage and its use has been limited. Uterine artery embolization is not recommended due to its negative impact on reproductive function, while focused ultrasonographic approaches are not yet well established. As of now, myomata and infertility is a subject that is open to further development due to the small number of randomized controlled trials in the field.Keywords: Assisted reproductive techniques; Infertility; Myoma; Myomectomy; Leimyoma

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