Clinical risk factors for infertility in reproductive-age patients with intramural uterine fibroids

Objective: To determine the clinical risk factors for infertility and develop a relative risk score for infertility in reproductive-aged patients with intramural uterine fibroids (UF). Materials and methods: This was a single-center retrospective case-control study with multivariate logistic regression. The study included an analysis of the medical records of 200 reproductive-age patients with intramural UF measuring 3–5 cm (FIGO 3–6 type), who were examined and treated at the University Clinic "I am healthy!" (clinical base of the Department of Obstetrics and Gynecology with a perinatology course at the People’s Friendship University) from 2017 to 2021. The patients were divided into two groups: 100 infertile women with intramural UF ("case") and 100 fertile patients with UF ("control"). Factors, such as complaints and diseases with a duration exceeding 12 months, which could potentially affect fertility at the time of pregnancy planning, were assessed. The development of a relative risk score scale involved selecting parameters and combining them into a score scale. The binary logistic regression method was used to predict single-step (prognostic) conditions such as infertility. Results: The relative risk score scale included anamnestic parameters such as long and heavy menstruation (lasting more than 12 months), chronic pelvic pain (lasting more than 12 months), insulin resistance, obesity (lasting more than 12 months), long-term iron deficiency anemia, history of endometrial hyperplastic processes, and phenotypic signs of undifferentiated connective tissue dysplasia (two or more signs). Mathematical calculations allowed us to determine the significance of each risk factor. The sum of these factors provides an estimate of the relative risk of infertility based on the obtained odds ratio value expressed in points. A score of >6 indicates an increased relative risk of infertility (p<0.001), while a score of >13 indicates a high relative risk of infertility with statistical significance (p<0.001). During the ROC analysis with recalculated point coefficients for each patient, we obtained a "cut off" value of 0.5035, above which the probability of infertility increased, reaching the maximum sensitivity and specificity. Conclusion: The developed relative risk point scale, which includes clinical and phenotypic parameters, can be a valuable tool for assessing the risk of infertility (as well as the potential causes of failure in in vitro fertilization programs) in patients with intramural UF, including during the stages of pregnancy planning. © A group of authors, 2024