Myomectomy for intramural fibroids improves pregnancy chances in women undergoing IVF

BACKGROUND: The role of myomectomy for intramural (IM) fibroids prior to artificial reproductive technique (ART) cycles is still debatable. This study assesses evidence regarding the effect of myomectomy for IM fibroids on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycle outcomes. METHOD: Online search of databases from June 1949 to February 2024 were performed. A literature search was performed using Ovid MEDLINE, EMBASE, and Cochrane Library databases. Medical subject headings and keywords were used to generate a subset of citations for myomectomy, fibroid, leiomyoma, assisted conception, ICSI, IVF, ART, and pregnancy outcomes. The PRISMA checklist was completed. RefWorks was used for reference management. Eligible studies were identified by two independent reviewers. Rayyan was used for data screening. RevMan v5 software was used for data screening, extraction, and synthesis. All women undergoing IVF/ICSI cycles with fresh or frozen embryo transfer with IM uterine fibroids were included. RESULTS: A total of 1572 studies were identified, with 423 assessed for eligibility, 118 duplicates removed, and 58 meeting the inclusion criteria. Seven studies were included in the systematic review. A total of 1644 women reported on in these seven studies. Results show a 63% higher chance of an ongoing pregnancy rate/live birth rate in those who underwent myomectomy compared to those who did not have myomectomy, prior to IVF (Relative Risk (RR) 1.64 (1.15-2.33); P ≤ 0.01). CONCLUSION: This systematic review of non-RCTs has shown beneficial effects, although there is significant variation in reporting fibroids by International Federation of Gynecology and Obstetrics classification and on reporting of the outcomes; hence, further well-designed studies are required. Individualized patient care for the decision to undergo a myomectomy prior to IVF/ICSI should be considered.