TREATMENT OF SUBMUCOUS FIBROIDS, AND OUTCOME OF ASSISTED CONCEPTION

Study Objective. To determine the effect of hysteroscopic resection and goserelin in the treatment of submucous fibroids, and their significance in assisted conception. Design. Patients with history of subfertility and previous failed attempts at assisted conception were examined by transvaginal sonography before further attempts at assisted conception. Those diagnosed as having submucous fibroids were treated with goserelin injections, hysteroscopic resection, or a combination of both. Saline sonohysterography was performed whenever the submucous nature of the fibroid was unclear. Setting. The Churchill Clinic Fertility and IVF Centre, London, United Kingdom. Patients. One hundred women being treated for subfertility over a period of 2 years. Twenty-seven had submucous fibroids diagnosed by transvaginal sonography and a comparable group of 73 had a normal uterine cavity. Interventions. Three doses of goserelin 3.6 mg subcutaneously at 4-week intervals were given, followed by hysteroscopic resection of the submucous part of fibroids if the fibroids remained submucous. Three patients had hysteroscopic resection without goserelin, as the fibroids were resectable when they were diagnosed. All patients underwent assisted conception within 3 months unless they conceived spontaneously in the interim. Measurements and Main Results. The pregnancy rate in patients with normal uterine cavity was 26%/embryo transfer, and 15.8% of these ended in a miscarriage. The pregnancy rate was significantly higher (p > 0.02) in the study group after treatment of submucous fibroids (48.2%/embryo transfer), and the miscarriage rate of 23. 1% was not significantly different. Conclusions. Submucous fibroids are a significant cause of subfertility. A combination of goserelin injections and hysteroscopic resection significantly improves pregnancy rates without increasing the miscarriage rate.