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Myomectomy for intramural fibroids improves pregnancy chances in women undergoing IVFWomen with fibroids had better pregnancy chances after myomectomy before IVF treatment

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Key Takeaway
Consider individualized myomectomy for intramural fibroids before IVF/ICSI based on patient discussion.

This systematic review and meta-analysis examined the impact of myomectomy on reproductive outcomes for women with intramural uterine fibroids undergoing IVF or ICSI cycles. The analysis included women with fresh or frozen embryo transfers who either underwent surgery or did not. The primary focus was on ongoing pregnancy and live birth rates. Results indicated a beneficial effect for the surgical group, showing a markedly higher chance of achieving these outcomes compared to the non-surgical group. The relative risk favored the intervention, suggesting a positive association between surgery and reproductive success in this specific population.

The authors noted significant limitations regarding the quality of the underlying data. There was substantial variation in how fibroids were reported using the International Federation of Gynecology and Obstetrics classification system. Additionally, the reporting of outcomes varied across the included studies. These inconsistencies introduce uncertainty into the pooled results and suggest that the magnitude of the benefit might be influenced by how the data were collected and categorized in the original reports.

Despite these limitations, the practice relevance suggests that individualized patient care is essential. Decisions to undergo myomectomy prior to IVF or ICSI should be carefully considered on a case-by-case basis. Clinicians must weigh the potential reproductive benefits against the risks of surgery, keeping in mind the heterogeneity of the evidence. The findings support a discussion with patients but do not mandate a universal recommendation for surgery before embryo transfer.

A big review of medical records looked at women having IVF or ICSI treatments. Many of these women had fibroids inside their uterine walls. The doctors compared those who had surgery to remove the fibroids with those who did not have surgery.

The main finding was very clear. Women who had the surgery had a much better chance of having a baby. About sixty-three percent more women got pregnant and had a live birth after the operation. This was a big improvement compared to women who kept their fibroids.

However, the study had some limits. Doctors reported the size and type of fibroids in different ways. This made it hard to compare every single case perfectly. Also, the study looked at records from many different places, not just one hospital.

Doctors say each patient is different. Some women might need surgery before trying for a baby with IVF. Others might not. Your doctor can help you decide what is best for your specific body and health needs.

What this means for you:
Surgery to remove fibroids before IVF may help women get pregnant more often.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
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.
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