Fibroids and infertility: A sort review
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Midwifery Department, University of West Attica, Athens, Greece
Publication date: 2023-10-24
Corresponding author
Giannoula A Kyrkou   

Midwifery Department, University of West Attica, Athens, Greece
Eur J Midwifery 2023;7(Supplement 1):A80
Uterine myomas are a very common medical condition that affects almost 70% of women worldwide. They have a strong connection with cases of infertility and are estimated to be the only reason behind it in about 2-3 % of infertility cases. In addition, myomas can affect pregnancy in the early stages, leading to recurrent pregnancy loss or complicated pregnancy in later stages. This paper is a short review of the existing bibliography on the connection between infertility and uterine myomas.

The purpose of this sort literature review is to clarify the role of fibroids in the occurrence of infertility, in the development of a pregnancy and in any coexistence with it.

Material and Methods:
For the purpose of writing this review articles from databases like PubMed and NCBI were collected, using the following search terms “infertility”, “uterine fibroids”, “Uterine fibroids and infertility”, “uterine fibroids treatment”, “uterine fibroids and pregnancy”, “hyperprolactinemia”. After a review of the results to this research the articles that were chosen to be concluded in this review were those with the most recent publication dates on the specific subject of research, with most of them having been published during the last 3 years.

From the pathogenesis, gene mutations appear (Med12 gene (~70% of UFs), the AT-hook 2 (~20%), biallelic inactivation of fumarate hydratase (FH~2%), and secretion of MicroRNAs, which affect the endometrium. Regarding the effect of the fibroid on the endometrium, it is detected in: 1. Low expression of HOHA10 and HOHA11 genes in 68.8% of fibroids coexisting with low implantation rates. 2. Low expression of the cytokines LIF and IL-11 3. Increase in TGF-β3 factor leading to decrease in BMPR-2 4. Increase of macrophages and decrease of Natural killer cells. 5. Disorder of contractility of the uterus (effect also from the pseudocapsule of the fibroid. 6. Coexistence of fibroids with pregnancy occurs in 3-12% of pregnant women. 7. Effect of fibroids on pregnancy: spontaneous abortion, abnormal fetal projection, placenta previa, premature labor, placental abruption, caesarean section, postpartum hemorrhage. Pregnancy can cause hemorrhage, necrosis, and histologic progression of the fibroid to leiomyosarcoma.

Fibroids are closely related to decreased fertility, and can potentially progress to malignancy.