The Impact of Non Cavity Distorting Intramural Fibroids on IVF Outcomes Systematic Review and Meta Analysis

However, there has been existence of an array of problems on this topic as far as medical literature is of concern. Fibroids in the uterine cavity express heterogeneity not only in the size and frequency but also in the composition and location1. Therefore, an alteration in any of the factors could result in an eminent alteration on the effects on the fertility. Several medical meta-analytical studies have been in place in an attempt to determine how leiomyoma influences fertility and there has been a wide disparity in findings as most of the studies have registered serious flaws in methodology. The designs of the investigations have frequented poor designs. Objectives The major objective of this paper was to investigate the impact of non-cavity distorting IM with or without SS besides investigating the impact of non-cavity distorting exclusive IM fibroid.

It also aims at investigating the impact of myomectomy on reproductive outcome of women undergoing IVF. Instead of a narrative review of literature, the paper applies meta-analytic techniques. Always consistent of a standard literature review is commentary findings derived from previous studies. However, the approach of this paper depicts a qualitative character, which neither offer room for qualitative assessing of the effect of interest nor enable its stabilization for the invariant methods applicable across studies7. 1 Electronic Searches The electronic databases, trial registers, as well as websites that will attract attention for literature searches include University of Phoenix Library’s ProQuest, CINAHL, PUBMED, the Cochrane Central Register of Controlled Trials, PsycINFO, and MEDLINE. Other electronic sources will include a search on Google Scholar database.

Search of Google Scholar presents results by relevance and ranking and takes into account the full text of documents10. It will be a helpful tool as it provides the source, author, and the frequency of its recent citation in publications of a common course11. An excerpt of the article is also shown with the search terms highlighted, the frequency of citation, and related articles. 2 Interventions Eligible for inclusion will be women with IM and/ or SS compared to women with no fibroids, women with exclusive IM compared to women with no fibroids, and post myomectomy women compared to women with IM and/ or SS fibroids. Factors of consideration in comparing the variables will be low birth rate (LBR), cumulative pregnancy rate (CPR), implantation rate (IR), and miscarriage rate (MR)19.

3 Outcome Measures Primary Outcomes i. Effectiveness: Live Birth Rate (LBR) defined as the number of deliveries that resulted in at least one live born baby expressed per 100 patients. ii. Subsequent to an initial screening of titles as well as abstracts obtained from the search, there will be a retrieval of a complete text of the eligible studies. Likewise, there will be an independent examination of the full text articles for any compliance with the criteria of inclusion in addition to a selection for studies, which are eligible for an inclusion in the review22. As per the requirements to the eligibility of the study, there will be a correspondence to the investigators. Resolution of disagreement to the eligibility of the study will ensue through either a discussion or a third party author review.

There will be an independent assessment of the risk of bias through the Cochrane tool for assessing risk of bias. 1 Data Synthesis In case there is a sufficient similarity shown by the studies, a combination of data will ensue using either a fixed effect model or a random effect model in the following comparisons: i. Women with IM and/ or SS compared to women with no fibroids while considering the following factors a. LBR b. CPR c. IR d. MR There will also be a graphical display of an increase in the odds of a specific outcome, which could be either beneficial as in the case of live births or detrimental in the meta-analysis to the right of the centerline whereas a decrease in the odds recorded to the left26.

3 Data Analysis 3. 0 RevMan 5. 3 There will be a review through RevMan 5. RevMan 5. Results 4. 1 Search Results Records identified through initial database screening (n=2482). Full-text articles assessed for eligibility (n=187). Studies included in data synthesis (n=58). Final studies included in meta-analysis (n=27). All the women in the intervention group had IM and/or SS fibroids, had either undergone myomectomy, or had IM and/or SS fibroids undergoing IVF iii. Outcomes 7 out of 26 studies reported IVF and ICSI. Likewise, 16 out of 26 studies exclusively reported IVF. However, only 3 out of 36 studies reported ICSI only31. 3 Excluded Studies There was an exclusion of some studies from the meta-analysis. Within the study bias, potential sources were evident in the other eight sources. 5 Comparing First and Second Objective i. Primary Outcomes Live Birth Rates The first objective (impact of IM ± SS) had an association with significantly decreased LBR in women with IM ± SS compared to women with no fibroids as shown in table 133.

Likewise, the second objective (Impact of exclusive IM fibroid) also had significantly decreased LBR in women with exclusive IM compared to women with no fibroids as shown in table 5. Adverse Events The first objective showed an association with significantly decreased CPR in women with IM ± SS compared to women with no fibroids as shown in table 2. However, the third objective showed no significant different CPR in post myomectomy women compared to women with IM & or SS fibroids as shown in table 10. ii. Secondary Outcomes Miscarriage Rate The first objective showed an association of significantly increased MR in women with IM ± SS compared to women with no fibroids as shown in table 436. However, the third objective showed no significant different MR in post myomectomy women compared to women with IM & or SS fibroids as shown in table 11.

Conclusion Systematic review as meta-analysis in evaluation of the association between non-cavity distorting IM fibroids and IVF outcome in an attempt to explore the available inconsistencies in the literature show a variety of findings. Gambadauro, Pietro. "Dealing with uterine fibroids in reproductive medicine. " Journal of Obstetrics and Gynaecology 32, no. Griffiths, A. , Arianna D’Angelo, and N. Marqueta, Belen, Pedro N. Barri, Buenaventura Coroleu, Pedro N. Barri Soldevila, and Ignacio Rodriguez. "Effect of non-cavity distorting intramural fibroids on assisted reproduction outcomes: a cohort study. " Journal of Endometriosis and Pelvic Pain Disorders 8, no. "Uterine fibroids: impact on fertility and pregnancy loss. " Obstetrics, Gynaecology & Reproductive Medicine 17. Ojo-Carons, Mary, Sunni L. Mumford, Alicia Y. Armstrong, Alan H. Sunkara, Sesh Kamal, et al. "The effect of intramural fibroids without uterine cavity involvement on the outcome of IVF treatment: a systematic review and meta-analysis.