Objective: To evaluate the effect of fibroids on outcome of IVF and
study value of myomectomy prior to IVF. Design: Prospective controlled
study. Setting: Private IVF center, The Egyptian IVF ET Center, Maadi,
Cairo. Materials and methods: One hundred and eighty four patients were
included. Sixty three patients with intramural fibroids were counseled
for either myomectomy or no treatment prior to IVF and decision left to
the patient. Group A, N=19 were treated by myomectomy, Group B, N=44
had no myomectomy. Group B were subdivided into B1, N=11 with fibroid
at a distance < 5 mm from the endometrial lining and B2, N=33 at a
distance of > 5 mm. Group C, N= 100 were an age-matched group of
infertility patients. Group D included 11 submucous fibroids and 10
fibroid polyps that were all treated by hysteroscopic resection. Main
outcome Measures: Size and distance of intramural fibroid to
endometrial lining were recorded. Outcome of IVF was compared between
fibroids at a distance > 5 mm and < 5 mm from endometrial lining.
As well as outcome between group that performed myomectomy and that
which did not undergo myomectomy. Results: Pregnancy rates achieved in
the three groups A, B and C were; 50%, 27.5% and 36% respectively. This
was found to be non significant. In subgroup B1 there was one pregnancy
(9%) as compared to 10 pregnancies in subgroup B2 (30%). The difference
was non significant. Following hysteroscopic resection 2 out of 6
patients with submucous fibroids and 6 out of 10 patients with fibroid
polyps became pregnant after IVF. Conclusions: The distance between the
intramural myomas and the endometrial lining did not affect the IVF
outcome. An insignificant tendency towards improvement of IVF outcome
was found in myomas at more than 5 mm from endometrial lining
