SUPPLEMENTARY INFERTILITY FACTORS IN PATIENTS WITH INTRAMURAL UTERINE FIBROIDS

Relevance: Uterine fibroids (UFs) are the most common neoplasms affecting women of reproductive age and consist of smooth muscle cells. UFs are not unequivocally associated with abnormal fertility; however, their negative impact on reproductive function is undisputed. Our analysis of the literature allowed us to formulate the hypothesis that in infertile patients with intramural UFs without uterine cavity deformity, there are other factors in addition to the local factors that are associated with implantation failure. Objective: This study aimed to investigate clinical and anamnestic supplementary infertility factors in patients with intramural UFs. Materials and methods: The study analyzed medical records of 370 patients of reproductive age with UFs (FIGO type 3–6) who were managed between 2017 and 2020. The patients were divided into two groups. The study group comprised 240 infertile patients with intramural UFs. The control group included 130 fertile patients with intramural UFs. Among them, 70 patients were in the first trimester of pregnancy, and 60 women were diagnosed with UFs before or during pregnancy and gave birth less than 12 months ago. Statistical analysis was performed using SPSS (version 10.0.7) and Statistica (version 8.0) for Windows. Differences between the groups were considered statistically significant at p<0.001. Results: This study demonstrated for the first time the presence of supplementary factors associated with infertility in patients with intramural UFs. These factors include a history of spontaneous miscarriage, iron deficiency anemia, several endocrine diseases (insulin resistance, obesity), and a combination of UFs with proliferative diseases of the reproductive system (endometrial hyperplasia/polyp, endometriosis of the uterus, and pelvic peritoneum). Iron deficiency anemia, cardiovascular diseases (arterial hypertension and mitral valve prolapse), and a significant risk factor for their development, such as hypercholesterolemia, were significantly more frequent in the group of infertile patients with UFs. A strong association has also been found between infertility in patients with UFs, long and heavy menstruation, and chronic pelvic pain. Conclusion: This study revealed that patients with intramural UFs have a set of supplementary factors associated with infertility. It is likely that the concomitant gynecological and extragenital pathological changes identified in patients with intramural UFs can be classified as risk factors for infertility. © 2023, Bionika Media Ltd.. All rights reserved.