Fibroid Removal May Be Key To Reducing Certain Recurrent Miscarriages

By some estimates, as many as 80% of women will have fibroids at some point in their lives. And, although many women are asymptomatic, their presence can cause extreme pain in some women and also may be a factor in infertility issues, with submucosal, intramural and subserosal fibroids (in a decreasing order of importance) impacting infertility. Moreover, some research has linked the presence of uterine fibroids with recurrent miscarriage in women, but the data thus far had been inconclusive.

With that in mind, Dr Sotirios H. Saravelos, clinical research fellow in the reproductive medicine and surgery unit at the University of Sheffield, UK, and colleagues looked at retrospective and prospective data from a large tertiary referral recurrent miscarriage clinic to determine if fibroids were causing the repeated miscarriage or if their presence was simply incidental. They also sought to determine if removing the fibroids would lead to improved outcomes.

To do so, Saravelos et al. looked at women who had at least three consecutive miscarriages up to 24 weeks of gestational age. Transvaginal ultrasound and hysterosalpingography were used to identify fibroids; fibroids that distorted the uterine cavity were resected via hysteroscopy. For the study, Saravelos and colleagues divided the women into three groups: those with cavity-distorting fibroids who underwent surgery (N=25), women with fibroids that were not distorting the cavity and did not undergo any intervention (N=54), and a control group of women who had unexplained recurrent miscarriage (N=285). With exception of age, patient demographics across the groups were similar; however, patients with fibroids were slightly older, on average, than those women with unexplained recurrent miscarriage (36.0 versus 31.4, respectively). The Figure shows the types of fibroids found.

Figure. Incidence of fibroids among study participants

Saravelos et al. found improved outcomes for women with fibroids distorting the uterine cavity following surgery. Before referral, the researchers found a total miscarriage rate of 76.7% and a live birth rate of 23.3%. The study authors found midtrimester loss rate dropped in the first pregnancy following surgery from 21.7% to 0.0%. Moreover, they found a significant increase in live birth rate, which increased from 23.3% to 52.0% (p<0.05).

Saravelos et al. also found improvement among women with fibroids that did not distort the uterine cavity. Prior to referral, live birth rate was 20.6% for women in this group. After referral (and without intervention), the birth rate reached 70.4%. The researchers noted that this rate was similar to the live birth rate observed in women with unexplained recurrent miscarriage after referral (71.9%).

Saravelos and colleagues noted their findings have clinical ramifications for treating women with recurrent miscarriages and fibroids. “Our data show that following myomectomy, the mid-trimester losses may be eliminated and translated into an equivalent increase in the live births,” they noted. Based on these results, they recommended “Any woman presenting with a previous history of mid-trimester loss should undergo thorough investigation for the presence of a fibroid.”
 
“Fibroids distorting the cavity have been shown to have the largest impact on fertility, implantation and possibly pregnancy loss and can be corrected safely via hysteroscopy, a minimally invasive procedure,” they reported. “For this reason, in our centre we offer hysteroscopy to all women with submucosal fibroids and RM in a ‘see and treat’ manner.”

Related Content:OBGYNFibroid Resource Center

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Reference:
Saravelos SH, Yan J, Rehmani H, Li TC. The prevalence and impact of fibroids and their treatment on the outcome of pregnancy in women with recurrent miscarriage. Hum Reprod. 2011; Sep 27 [Epub].