Investigating Leiomyoma Growth During IVF-Assisted Pregnancies - Research Paper

Objective

We aim to get accurate information about the possibility of growth of leiomyoma during pregnancy after IVF cycles, and to determine if there is any relationship between the growing of leiomyoma with adverse pregnancy outcomes. (Adverse pregnancy outcomes mean: pregnancy complications, pregnancy specific disease, childbirth complication, mode of delivery, intraoperative and postoperative blood loss)

Is your time best spent reading someone else’s essay? Get a 100% original essay FROM A CERTIFIED WRITER!

Order now

From this objective we should measure the changing of the size of the leiomyoma during and after pregnancy from the two groups so that we can compare if there will be any difference from the results about the size of leiomyoma and the comparative and the statistic study about the relationship between growth of leiomyoma and adverse pregnancy outcomes.

Study Design

This prospective cohort study was carried out at Department of Obstetrics in Xiang Ya Hospital in Central South University in China between1 May 2017 to 31 March 2019. The data was collected using questionnaires given to the patients and also from by the hospital's records. The prevalence of leiomyoma in pregnant women was examined using ultrasound examination. The Pregnant women after IVF were compared to women who had unprompted pregnancy.

Materials and Methods

The information provided from the patients questioner and the hospital's records where analyzed using SPPS. Pregnant women with leiomyoma were imagined during the ultrasonography study of their fetal anatomy, regularly performed within the period of their pregnancy in the prenatal clinic at Xiang Ya hospital. Both Inferential and descriptive analysis were carried out

Results

From 39 women undergoing IVF: 18 women (46.2%) were handled with a long GnRH agonist protocol, and 21 women (53.8%) were administrated with a protocol with GnRH antagonists. The mean SD duration of ovarian stimulation was 10.1 2.3 days. 30.8% of the women who had a pregnancy after IVF were infertile for three years, 17.9% were infertile for four, five and six years, 2.6% were infertile for nine years, and 5.1% were infertile for only one year. Conclusion

The size of leiomyoma significantly increases during pregnancy for women with pregnancy after IVF compared to that of women with spontaneous pregnancy. IVF does not only affect the size of the fibroids but also the location of the fibroids

Introduction

The expressions: ("leiomyoma", Uterine fibroids", "myoma", "fibromyoma", "hysteromyoma", "fibroma",) are synonymous (World Health Organization, 1948). Leiomyoma is a neoplasm of smooth muscle origin and is a benign tumor arising from the myometrium, and describe as a type of monoclonal benign tumor (Williams, 2017). Leiomyomas are tumors in the form of fibroids that occur in the uterine walls and differ greatly in terms of size, shape and time of growth (Khan, 2014). The fibroids are not cancer and have a minimal chance of turning into cancer tumors ("Multiple Leiomyoma Consortium"). They have no specific position in the uterine walls and may be found either inside the walls, outside the walls or just within the walls (Wallach, 2004).Its growth depends on different factors, and it has varying growth periods: to certain people, it may take very long to grow, but when it does, it multiplies rapidly and to others, it may grow slowly but consistently depending on different factors (Maruo, 2004). These fibroids can affect women of any age although most of them are found in women aged between 30-40 years (Zimmermann, 2012). They have different symptoms such as menstruation problems including changes in menstrual periods, vaginal bleeding instead of menstruation which can eventually lead to anemia, and painful menstruation, periods of pain the back as well as in the lower part of the abdomen, pain during sex, bloated uterus, and abdomen, miscarriages, stillbirth, infertility, among others ("Uterine fibroids, n.d."). These fibroids are also the most common indication of hysterectomy (Stewart, 2001).

In the USA, the lifetime risk of uterine leiomyoma development in women is estimated to be up to 75% (Commandeur, 2015). It is the most frequently occurring benign tumors of the uterus and female genital tract, and the incidences reported are very wide-ranging from 5.4 to 77% (Sparic, 2015). The incidence of uterine fibroid tumors increases as women grow older and they may occur in more than 30 percent of women 40 to 60 years of age (Evans, 2007).

The prevalence of uterine leiomyomas with pregnancy has been reported to range from 0.1% to 11 % (Cook,2010), but is probably underestimated because of the limitations of physical examination during pregnancy and because of a lower diagnostic delicacy of sonography in pregnant women, while the prevalence in women undergoing in vitro fertilization (IVF) treatment may exceed 25% (Cai, 2017). However, considering the growing trend of retarding childbearing and the rising rate of obesity, the incidence of leiomyoma during pregnancy is likely to increase in the future (Crain, 2008). Older women were more likely to develop gestational diabetes, preeclampsia, placenta previa, and operative vaginal delivery (Bianco, 1996). A study including women aged 45 and above showed that the rates of cesarean delivery (OR, 31.8; 95% CI, 18.0-56.1), placenta previa, postpartum hemorrhage, and adverse neonatal outcome were significantly higher and the risk for gestational diabetes mellitus, preeclampsia toxemia, preterm delivery, and neonatal intensive care unit admission was increased for women aged 50 years (Yogev, 2010). Also in regards to age, "advanced age for women is a big risk factor for female infertility, infertility loss, fetal anomalies, stillbirth, and obstetric complications These observations have been done over a long period of time and still it doesn't change women's delay in childbearing that has become common nowadays. Today's women are focused on education and careers while keeping waiting for long to give birth. This has consequently led to older women experiencing infertility, recurrent pregnant loss as well as pregnancy complications" (Sauer, 2015).

Leiomyoma are asymptomatic in most patients (80%), but if symptoms do occur, leiomyoma can negatively affect quality-of-life (Borah, 2013). The frequency of the condition is, however,likely to be underestimated because in many women it is asymptomatic, or symptoms develop insidiously, and therefore remains undiagnosed (Stewart, 2017) As well leiomyoma may negatively impact pregnancy outcomes, but the impact is vague. Literature studies also have been controversy regarding the impact of a leiomyoma on the pregnancy outcomes for patients underwent assisted reproductive technologies if the leiomyoma didn't compress the uterine cavity (Levy, 2012). Furthermore, recent surveys studied several controlled populations of patients undergoing IVF cycles to determine the effect of a leiomyoma on multiple outcome variables, including implantation, miscarriage rates and ongoing pregnancy (Abuzeid, 2018).

Many studies have notified that the presence of leiomyoma affects conceptions after IVF, whereas other studies showed no differences in the outcomes of IVF cycles of women with smaller intramural leiomyomas which do not compact the uterine cavity (Lisiecki, 2017).

On the other hand, Leiomyomas during pregnancy may encounter significant changes like necrosis, hemorrhage and various degenerative changes, which can accompany leiomyomas in about half of these patients (Kaminski, 2013). On the other hand, it is commonly believed that leiomyomas undergo accelerated expansion during pregnancy because of the influence of hormones. Recent researches have reported that dimensions of leiomyoma during pregnancy, frequently remain unchanged, or even decrease in size (De Vivo, 2011). Table (1). Currently, most references give maximal plausibility to the hypothesis that submucosal leiomyoma is related to the greatest negative effect on implantation and placentation, but the role of other types of leiomyoma is more controversial "We examined the published relationship between uterine fibroids and reproductive outcomes. Submucosal fibroids had the strongest association with lower ongoing pregnancy rates, odds ratio, 0.5; 95% confidence interval, 0.3-0.8, primarily through decreased implantation. Cumulative pregnancy rates appeared slightly lower in patients with intramural fibroids 36.9% vs 41.1%, which may reflect biases in the literature; however, patients with intramural fibroids also experienced more miscarriages, 20.4% vs 12.9%. Adverse obstetric outcomes are rare and may reflect age or other differences in fibroid populations. Increased risk of malpresentation (odds ratio, 2.9; 2.6-3.2), cesarean (odds ratio, 3.7; 3.5-3.9), and preterm delivery (odds ratio, 1.5; 1.3-1.7) are reported; however, the incidence of labor dystocia was low (7.5%). There was no conclusive evidence that intramural or subserosal fibroids adversely affect fecundity. More prospective, controlled trials are needed to assess the effects of myomectomy. Good maternal and neonatal outcomes are expected in pregnancies with uterine fibroids. 2008 Mosby, Inc. All rights reserved."