The Effects of Myoma and Uterine Preserving Procedures for Myoma on Pregnancy Outcomes

Abstract

Uterine myomas are the most common benign tumors in reproductive aged women. There have been concerns about fertility and obstetric complications in pregnant women with myomas. Currently, maternal age for pregnancy is increasing, and uterine-preserving therapeutic procedures of uterine fibroids such as myomectomy, high-intensity focused ultrasound (HIFU), or uterine artery embolization (UAE) have increased. However, it is unclear whether those treatments can improve fertility and pregnancy outcomes. Recent data suggest that pregnancies after uterus-preserving procedures are associated with obstetric complications such as cesarean section, placenta previa, preterm labor, premature birth, and low birth weight. The biggest obstetric concern in pregnancies after uterine-preserving procedures is uterine rupture during pregnancy, which can threaten the survival of fetuses. Moreover, uterine rupture after myomectomy is more likely to occur before labor onset. Most international guidelines suggest that myomectomy be considered for a woman with uterine myomas who has undergone several unsuccessful in vitro fertilization cycles despite appropriate ovarian response and good-quality embryos or for a woman with symptomatic myomas. In addition, HIFU or UAE treatments are relative contraindications in women with a future pregnancy plan, because there are limited data about associated pregnancy outcomes, and UAE can affect fertility after the procedure. The risks of uterine rupture and of obstetric complications in pregnancies after myomectomy should be discussed in affected women with a future pregnancy plan.