Fertility Before and After Myomectomy

The fertility of women with fibroleiomyoma, classified as benign uterine tumors of mesenchymal origin, can be different from that of women without these lesions. According to many authors, myomas are not a common reason for primary infertility and are a single main reason for infertility in a very low percentage of patients. However, others state that the course of pregnancy may be affected by both the size and location of myomas, so whether myomas have an unfavorable effect on fertility remains open. It is generally believed that location and size play a primary role in prognosticating lesser or greater negative impact of myomas on conception and subsequently, but not secondarily, on the course of pregnancy. Submucosal, intramuscular, and subserous locations are discussed in decreasing order of significance of impact. A location that distorts the internal anatomy of the uterus and ruins the smoothness of its surface is compared to the presence of a foreign body in the uterus which, by analogy to the contraceptive effect of intrauterine devices, may explain its potential anti-procreative impact. Myomas in the muscular wall of the uterus, so-called intramural myomas, as well as their passage towards the mucosal layer, or primarily submucosal myoma, may have a significant impact on the still mysterious contractile activity of the uterine muscular coat at the time of implantation of the embryo and its early developmental stages. A further negative effect of targeting pathological contractions in the later stages of pregnancy cannot be excluded. Further research is necessary in basic studies to answer questions on the molecular and genetic mechanisms of myoma development and the associated mechanisms of infertility or failure to carry a pregnancy to term in the context of investigating therapeutic possibilities, especially regarding prevention in genetically susceptible individuals. Moreover, further research is necessary for therapies inhibiting the proliferation of smooth muscle fibers (Adv Clin Exp Med 2009, 18, 2, 107-113).