IVF vs Spontaneous Pregnancies: Leiomyoma & Complications - Research Paper

Abstract

Material and methods: To quiz the hypothesis, the study included subjects with singleton pregnancies and at least one intramural leiomyoma in Xiangya hospital in China from 1 May 2017 to 1 May 2019. The information collected through the use of questionnaires and hospital records. It went ahead to compare the size of leiomyoma and pregnancy complications between both groups, group A consisted of women who got pregnant through IVF, and group B were women who had spontaneous pregnancies and acted as the control experiment.

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Results: From 92 participants with intramural leiomyoma, 39 (1.3%) pregnant were after IVF, and 53 (5%) women were with spontaneous pregnancy. We noticed that the growth of leiomyoma in group A was considerably and particularly during the first trimester of pregnancy (2.31.267 vs 3.06 1.751; p 0.024). Also, there was a higher occurrence of pregnancy complications in group A than B such preterm delivery (47% vs 20%), a cesarean delivery (80.5% vs 69.4%), and postpartum hemorrhage (26% vs 12%).

Conclusion: The significant growth of leiomyoma during the initial pregnancy after the IVF cycle indicated the role of IVF medicaments on the size of leiomyoma. The research indicated that there was a relationship between the growths of a leiomyoma and increase in pregnancy complications.

Keywords: leiomyoma, pregnancy, IVF, pregnancy outcome, leiomyoma size.

Abbreviations: IVF: in vitro fertilization, PTD: preterm delivery, IUGR: intrauterine growth restriction, PROM: premature rupture of membranes, BMI: body mass index.

Key Message: The size of uterine leiomyoma increased in most patients who underwent controlled ovarian hyperstimulation protocols during the IVF cycles and this changing in size increased the complications during pregnancy in case of success of the IVF process.

Introduction

Leiomyoma is a neoplasm of smooth muscle origin and is a non-cancerous lesion, and describe as a type of monoclonal benign tumor (Ragni, 2010). It is the most frequently occurring tumors of the uterus and female genital tract, with a very wide-ranging of incidence from 5.4 to 77%, and from 0.1% to 11 % during pregnancy, while in women experiencing in vitro fertilization (IVF) treatments may surpass 25% (Stewart, 2013). Because as a reason for the increasing trend of retarding childbearing. Besides, the incidence of leiomyoma increases with age. It is possible that the incidence during pregnancy will rise in the future. It is normally accepted that leiomyomas undergo quickened expansion during pregnancy on account of the impact of hormones. However, we found in the literature that the results are conflicting. It is important to note that changing the size of leiomyoma after hyperstimulation of ovary during IVF cycles is incompatible.

Leiomyomas are asymptomatic in most patients (80%) and don't cause any health effects of a person hence can go unnoticed, but if symptoms do occur, leiomyoma can negatively affect quality-of-life (Guan, 2017). As well during pregnancy leiomyoma may negatively impact pregnancy outcomes, but this impact in literary studies is vague. Literature studies also have controversial regarding the impact of a leiomyoma on assisted reproductive technologies outcomes including implantation, miscarriage rates, and ongoing pregnancy (Styer, 2015).

Considering the increasing prevalence of leiomyoma in pregnancy period, especially in cases of infertility and require IVF, what's more, the likelihood of relationship between the size of leiomyoma and negative pregnancy events , even the specific period of pregnancy in which the growth might occur more frequently and the factors affecting these changes should be better understood. So, getting accurate information about the possibility of growth of such tumors after IVF cycles or during pregnancy is crucial to make a good decision before IVF and prenatal counseling. Also, it is important to know if there is any relationship between the growth of leiomyoma and adverse pregnancy outcomes. To shed light on this topic and to provide accurate results that will eradicate the confusion, we hypothesized that leiomyoma growth may mostly occur after the IVF cycle and during early pregnancy so we studied only pregnant women.

Materials and Methods

The prospective cohort study involved a survey of pregnant women with intramural leiomyoma at Department of Obstetrics in Xiangya Hospital in Central South University in China between 1 May 2017 to 1 May 2019. To reach the objective of the study, all singleton pregnancies with at least one intramural leiomyoma were included. The presence of leiomyoma was confirmed through the use of ultrasound examinations. Data were collected using questionnaires to the patients and gathered information on the expected obstetric and neonatal outcomes from the maternity database and chart review.

Pregnant women with leiomyoma were visualized during an ultrasonographic study of fetal anatomy, routinely performed during pregnancy in the prenatal clinic at Xiang Ya hospital. Inclusion criteria were: singleton pregnancy of between about 6 weeks gestational age and the term with at last one visible intramural leiomyoma, which don't impair the endometrium. Exclusion criteria were: patients with any leiomyoma encroaching on the cavity of the uterus, patients with difficult in ultrasound to evaluate the characteristics of the leiomyoma or if there was any suspected adenomyosis, patients who previously underwent myomectomy if there wasn't any visible intramural leiomyoma during pregnancy, and multiple pregnancies.

Pregnant women after IVF were compared to women who had a spontaneous pregnancy. So two groups of pregnant women were recruited: the case group (group A) were women with leiomyoma reaching a viable pregnancy as affirmed by ultrasound examination after 4 weeks of embryo transfer (ET) and by vHCG taste, and control group (group B) were pregnant women with leiomyoma achieving a viable spontaneous pregnancy and in 6 weeks from the first day of last period, controls were matched to cases by study period. The checking during pregnancy was done by physicians with specific practice in obstetric sonography. The analysts got informed consent from all recruited patients.

To reach the aim of this study we compared the association of intramural leiomyoma growth during pregnancy between group A and group B and tried to determine the association of non-cavity-distorting leiomyoma and adverse pregnancy outcomes between our two groups.

The study's participants were pregnant women of 4 weeks after ET in group A and 6 weeks gestational age in group B. Patients selected as group A they underwent during the IVF cycle serial ultrasound and hormonal checking; these patients underwent either standard long GnRH agonist protocol or short protocol. The mean SD duration of ovarian hyperstimulation was 10.1 2.3 days. In this group, leiomyoma size and location were followed throughout the pregnancy in cases of success the cycle of IVF, also after delivery, further ultrasound examination had done. Then change in the size of leiomyoma was analyzed for five times as following period: 4 weeks after ET in group A or 6 weeks of gestation age in group B, then in 14 weeks (end of the first trimester), 27 weeks (end of the second trimester), before delivery (end of the third trimester), and then 4 weeks after delivery, the precise location and dimensions of the leiomyoma was performed at these times. The sonographic appearance of leiomyoma was characterized as symmetrical, well-characterized, hypoechoic and heterogeneous masses.

The research classified leiomyomas which distorts the cavity line as submucosal and, as mentioned earlier, pregnant with these lesions were excluded from our study. On the other side, we divided the period of our study to four subperiod which were: subperiod a (6 weeks to 14 weeks), subperiod b (from 14 weeks to 27 weeks), subperiod c (from 27 weeks to delivery), and subperiod d (from delivery to 4 weeks after delivery). Leiomyoma was considered unchanged if its size at the next scan was within 10% of the last measurement. All scans were performed by experienced doctors who were blinded to the previous status of these pregnant. Selected women did not experience surgery for leiomyoma between the two checking before delivery. The mean SD time between the two echographic evaluations was 4.6 3.4 months.

Anteroposterior, transverse, and longitudinal diameters were measured, and the average diameter was used to indicate the size. When an individual had more than one leiomyoma, the study focused on the dimensions of the large-sized leiomyoma during growth pattern analysis.

So Main Outcome Measures were the size (cm) of a leiomyoma with Obstetric and neonatal outcomes. Obstetric and neonatal outcomes include breech presentation, mode of delivery, preterm delivery (PTD), placenta previa, placental abruption, during and pre-operation bleeding, premature rupture of membranes (PROM) and neonatal birth weight. These adverse outcomes were compared between the two groups then further examined within our two groups, as related to the size of the leiomyoma. The rates of preterm delivery considered as gestational age less than 37 weeks. The growth of leiomyoma, was calculated and the changes in the leiomyoma size were defined as follows: increased of the leiomyoma , if it grew by 10% of its size from the first scan; stable, if the leiomyoma stayed within 10% of its size from the first scan; decreased, if the leiomyoma decreased by 10% of its size from the first scan; and "disappeared," if at follow-up scans the leiomyoma could no longer be identified or distinguished in the uterus[24]. Univariate evaluation and multivariate logistic regression evaluation were performed.

The collected information was analyzed by using SPSS software, version 22. The study focused on providing descriptive statistics to compare and contrast the findings. It involved evaluating the diameters of the leiomyoma during and after pregnancy as the subjects underwent examination through ultrasonography. T-test technique was used to compare the per-natal period results and the development of leiomyoma. The evaluation went ahead to report the results in terms of mean SD trough SPSS; for the inference objective, we considered the statistical significance at p < 0.05. The research collected the data expressed as n and percentages on variables such as age. The study used the Chi-square test to compare the pregnancy complications between the two groups under 99% C.L. The research employed the paired t-test to analyze the change of the size of leiomyoma within the subperiods in both groups. The findings expressed in percentage represented the rate of complications and dimensions of fibroids using the denominator of either 39 (group A) or 53 (group B).

Ethical Approval

All procedures in this study were...