An excellent review was published in the April 2008 issue of the American Journal of Obstetrics and Gynaecology. Briefly, the data confirms that submucous fibroids are associated with a 20 per cent decrease in pregnancy rate as compared to infertile women with no fibroids. Most infertility specialists therefore recommend removal of these fibroids to enhance pregnancy rates. Though actual scientific evidence to support this strategy is limited, hysteroscopic myomectomy is an important treatment modality to improve pregnancy rates and should be considered, especially as the safety of this procedure is well-established.

Intramural fibroids may decrease pregnancy rates slightly, but this should be viewed with caution since most journals tend to publish papers showing positive effects. Currently, routine removal of intramural fibroid for optimizing pregnancy rate is not justified unless it is larger than seven cms or there has been a previous IVF failure. And certainly removal of subserous fibroids does not enhance fertility. This is about fibroids in those women who have realized, after one year of trying to conceive, that they are infertile. The crucial question concerns those who have not attempted to conceive as yet or have tried for less than a year and have been incidentally diagnosed as fibroids. They desire a future pregnancy and wish to be ‘fit’ for it. This review confirms that pregnancy with fibroids is associated with increased rates of preterm delivery, caesarean section and haemorrhage. Simultaneously, most women with asymptomatic fibroids conceive easily and remain well enough throughout pregnancy and labour, very often achieving normal delivery even with large fibroids. The risks such women may be exposed to are not high enough to justify the costs of hospitalization and surgery, however easy and safe it may be.

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