Impact of leiomyoma on fertility

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Abstract

The article provides an overview of recent studies on the effect of uterine leiomyoma on fertility and pregnancy outcomes. We performed this work in accordance with international standards for systematic reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) with the analysis of data obtained across PubMed, Cochrane, Google Scholar, and other databases. The reference search method was also used to select articles. The search strategy did not include restrictions on language and source type.

The review examines the mechanisms through which uterine leiomyoma disrupts reproductive function, including mechanical barriers to conception, changes in the endometrial microenvironment, as well as impaired angiogenesis and uterine contractility. Special attention was paid to the impact of uterine leiomyoma on the results of assisted reproductive technology treatments.

Studies show that submucosal and intramural leiomyomas may reduce implantation and pregnancy success, especially in in vitro fertilization. However, the results remain contradictory, which indicates the need for further research. The work focuses on current treatment options for uterine leiomyomas in women of reproductive age, including drug therapy, myomectomy, and minimally invasive interventions such as uterine artery embolization and focused ultrasound ablation. Although minimally invasive interventions do not appear to affect ovarian function or worsen pregnancy outcomes, more randomized controlled trials are needed to recommend these methods for the treatment of uterine leiomyoma in patients with reproductive plans. Promising developments in the treatment of the disease are currently pathogenetic therapy with gonadotropin-releasing hormone antagonists and agonists, as well as selective progesterone receptor modulators, which affect not only symptoms but also sizes of uterine leiomyoma. However, conclusions about this therapy before surgery are debatable. The work highlights the importance of a comprehensive approach to uterine leiomyoma treatment and the development of personalized strategies for women with uterine leiomyoma planning pregnancy.

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About the authors

Aidar M. Ziganshin

Bashkir State Medical University

Author for correspondence.
Email: Zigaidar@yandex.ru
ORCID iD: 0000-0001-5474-1080
SPIN-code: 2037-3120

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Ufa

Sofya V. Erushenkova

Russian University of Medicine

Email: Sonya.erushenkova@bk.ru
ORCID iD: 0009-0003-8367-4077
Russian Federation, Moscow

Aliya R. Yanbarisova

Bashkir State Medical University

Email: yanbarisova1999@mail.ru
ORCID iD: 0000-0003-3799-4080
SPIN-code: 4788-8055
Russian Federation, Ufa

Galina B. Dikke

Academy of Medical Education named after F.I. Inozemtsev

Email: galadikke@yandex.ru
ORCID iD: 0000-0001-9524-8962
SPIN-code: 5913-1777

MD, Dr. Sci. (Medicine)

Russian Federation, Saint Petersburg

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия Эл № 77 - 6389 от 15.07.2002 г.