EFFECT OF INTRAMURAL, SUBSEROSAL, AND SUBMUCOSAL UTERINE FIBROIDS ON THE OUTCOME OF ASSISTED REPRODUCTIVE TECHNOLOGY TREATMENT

Objective: To investigate the effect of subserosal, intramural, and su bmucosal fibroids on the outcome of assisted reproductive technology ( ART) treatment. Design: A retrospective comparative study. Setting: A tertiary referral center for infertility. Patient(s): Treatment outcom e of 106 ART cycles in 88 patients with uterine fibroids (33 subserosa l, 46 intramural without cavity distortion; and 9 submucosal) was comp ared with that of 318 ART cycles in age-matched patients without fibro ids. Intervention(s): Controlled ovarian hyperstimulation and ART. Mai n Outcome Measure(s): Findings on transvaginal uterine ultrasonography performed before the initiation of treatment and pregnancy and implan tation rates.Result(s): The pregnancy rates per transfer were 34.1%, 1 6.4%, 10%, and 30.1% in the patients with subserosal fibroids, intramu ral fibroids, submucosal fibroids and no fibroids, respectively. The i mplantation rates were 15.1%, 6.4%, 4.3%, and 15.7%, respectively. Bot h rates were significantly lower in patients with intramural fibroids than in those with subserosal fibroids or no fibroids. Conclusion(s): Pregnancy and implantation rates were significantly lower in the group s of patients with intramural and submucosal fibroids, even when there was no deformation of the uterine cavity. Pregnancy and implantation rates were not influenced by the presence of subserosal fibroids. Surg ical or medical treatment should be considered in infertile patients w ho have intramural and/or submucosal fibroids before resorting to ART treatment. (Fertil Steril(R) 1998;70:687-91. (C) 1998 by American Soci ety for Reproductive Medicine.).