Fibroids and Infertility: Principles and Techniques of Management

  • A. Amoako
  • Bolarinde Ola


Uterine fibroids occur commonly in women of reproductive age group and may play an etiological role in infertility and pregnancy wastage in a significant number of women. Several studies have suggested an association between uterine fibroids and adverse pregnancy outcomes such as reduced fertility and increased miscarriage. Management of uterine fibroids to improve fertility and reduce pregnancy wastage is currently surrounded by considerable uncertainty and remains controversial. In managing uterine fibroid-associated infertility, clinicians must balance the potential benefits in the context of fertility enhancement with complications of the procedure.


Fibroids and infertility Uterine fibroids Leiomyomas Myomas Benign gynaecologic tumors Robot-assisted laparoscopic myomectomy Laparoscopic myomectomy 


  1. 1.
    Taylor DK, Leppert PC. Treatment for uterine fibroids: searching for effective drug therapies. Drug Discov Today Ther Strateg. 2012;9(1):e41–9.PubMedCentralPubMedGoogle Scholar
  2. 2.
    Eltoukhi HM, Modi MN, Weston M, Armstrong AY, Stewart EA. The health disparities of uterine fibroid tumors for African American women: a public health issue. Am J Obstet Gynecol. 2014;210(3):194–9.PubMedCentralPubMedGoogle Scholar
  3. 3.
    Stewart EA, Nicholson WK, Bradley L, Borah BJ. The burden of uterine fibroids for African-American women: results of a national survey. J Womens Health (Larchmt). 2013;22(10):807–16.Google Scholar
  4. 4.
    Borah BJ, Nicholson WK, Bradley L, Stewart EA. The impact of uterine leiomyomas: a national survey of affected women. Am J Obstet Gynecol. 2013;209(4):319.e311–20.Google Scholar
  5. 5.
    Puri K, Famuyide AO, Erwin PJ, Stewart EA, Laughlin-Tommaso SK. Submucosal fibroids and the relation to heavy menstrual bleeding and anemia. Am J Obstet Gynecol. 2014;210(1):38.e31–7.Google Scholar
  6. 6.
    Hart R. Unexplained infertility, endometriosis, and fibroids. BMJ. 2003;327(7417):721–4.PubMedCentralPubMedGoogle Scholar
  7. 7.
    Fernandez H, Sefrioui O, Virelizier C, Gervaise A, Gomel V, Frydman R. Hysteroscopic resection of submucosal myomas in patients with infertility. Hum Reprod. 2001;16(7):1489–92.PubMedGoogle Scholar
  8. 8.
    Buttram VC, Reiter RC. Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril. 1981;36(4):433–45.PubMedGoogle Scholar
  9. 9.
    Stewart EA. Uterine fibroids. Lancet. 2001;357(9252):293–8.PubMedGoogle Scholar
  10. 10.
    Wallach EE, Vlahos NF. Uterine myomas: an overview of development, clinical features, and management. Obstet Gynecol. 2004;104(2):393–406.PubMedGoogle Scholar
  11. 11.
    Sami Walid M, Heaton RL. The role of laparoscopic myomectomy in the management of uterine fibroids. Curr Opin Obstet Gynecol. 2011;23(4):273–7.PubMedGoogle Scholar
  12. 12.
    Viswanathan M, Hartmann K, McKoy N, et al. Management of uterine fibroids: an update of the evidence. Evid Rep Technol Assess (Full Rep). 2007;(154):1–122.Google Scholar
  13. 13.
    Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100–7.PubMedGoogle Scholar
  14. 14.
    Ciarmela P, Critchley H, Christman GM, Reis FM. Pathogenesis of endometriosis and uterine fibroids. Obstet Gynecol Int. 2013;2013:656571.PubMedCentralPubMedGoogle Scholar
  15. 15.
    Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol. 1990;94(4):435–8.PubMedGoogle Scholar
  16. 16.
    Segars JH, Parrott EC, Nagel JD, et al. Proceedings from the Third National Institutes of Health International Congress on Advances in Uterine Leiomyoma Research: comprehensive review, conference summary and future recommendations. Hum Reprod Update. 2014;20(3):309–33.PubMedGoogle Scholar
  17. 17.
    Marsh EE, Ekpo GE, Cardozo ER, Brocks M, Dune T, Cohen LS. Racial differences in fibroid prevalence and ultrasound findings in asymptomatic young women (18–30 years old): a pilot study. Fertil Steril. 2013;99(7):1951–7.PubMedGoogle Scholar
  18. 18.
    Marsh EE, Brocks ME, Ghant MS, Recht HS, Simon M. Prevalence and knowledge of heavy menstrual bleeding among African American women. Int J Gynaecol Obstet. 2014;125(1):56–9.PubMedCentralPubMedGoogle Scholar
  19. 19.
    Marshall LM, Spiegelman D, Barbieri RL, et al. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol. 1997;90(6):967–73.PubMedGoogle Scholar
  20. 20.
    Catherino WH, Eltoukhi HM, Al-Hendy A. Racial and ethnic differences in the pathogenesis and clinical manifestations of uterine leiomyoma. Semin Reprod Med. 2013;31(5):370–9.PubMedCentralPubMedGoogle Scholar
  21. 21.
    Munro MG. Uterine leiomyomas, current concepts: pathogenesis, impact on reproductive health, and medical, procedural, and surgical management. Obstet Gynecol Clin North Am. 2011;38(4):703–31.PubMedGoogle Scholar
  22. 22.
    Bulun SE. Uterine fibroids. N Engl J Med. 2013;369(14):1344–55.PubMedGoogle Scholar
  23. 23.
    Eggert SL, Huyck KL, Somasundaram P, et al. Genome-wide linkage and association analyses implicate FASN in predisposition to Uterine Leiomyomata. Am J Hum Genet. 2012;91(4):621–8.PubMedCentralPubMedGoogle Scholar
  24. 24.
    Rein MS, Powell WL, Walters FC, et al. Cytogenetic abnormalities in uterine myomas are associated with myoma size. Mol Hum Reprod. 1998;4(1):83–6.PubMedGoogle Scholar
  25. 25.
    Layman LC. The genetic basis of female reproductive disorders: etiology and clinical testing. Mol Cell Endocrinol. 2013;370(1–2):138–48.PubMedCentralPubMedGoogle Scholar
  26. 26.
    Islam MS, Protic O, Giannubilo SR, et al. Uterine leiomyoma: available medical treatments and new possible therapeutic options. J Clin Endocrinol Metab. 2013;98(3):921–34.PubMedGoogle Scholar
  27. 27.
    Ciarmela P, Islam MS, Reis FM, et al. Growth factors and myometrium: biological effects in uterine fibroid and possible clinical implications. Hum Reprod Update. 2011;17(6):772–90.PubMedCentralPubMedGoogle Scholar
  28. 28.
    Santulli P, Borghese B, Lemaréchal H, et al. Increased serum oxidative stress markers in women with uterine leiomyoma. PLoS One. 2013;8(8):e72069.PubMedCentralPubMedGoogle Scholar
  29. 29.
    Islam MS, Protic O, Stortoni P, et al. Complex networks of multiple factors in the pathogenesis of uterine leiomyoma. Fertil Steril. 2013;100(1):178–93.PubMedGoogle Scholar
  30. 30.
    Ciavattini A, Di Giuseppe J, Stortoni P, et al. Uterine fibroids: pathogenesis and interactions with endometrium and endomyometrial junction. Obstet Gynecol Int. 2013;2013:173184.PubMedCentralPubMedGoogle Scholar
  31. 31.
    Rein MS, Barbieri RL, Friedman AJ. Progesterone: a critical role in the pathogenesis of uterine myomas. Am J Obstet Gynecol. 1995;172(1 Pt 1):14–8.PubMedGoogle Scholar
  32. 32.
    Ishikawa H, Reierstad S, Demura M, et al. High aromatase expression in uterine leiomyoma tissues of African-American women. J Clin Endocrinol Metab. 2009;94(5):1752–6.PubMedCentralPubMedGoogle Scholar
  33. 33.
    Cicinelli E, Romano F, Anastasio PS, Blasi N, Parisi C, Galantino P. Transabdominal sonohysterography, transvaginal sonography, and hysteroscopy in the evaluation of submucous myomas. Obstet Gynecol. 1995;85(1):42–7.PubMedGoogle Scholar
  34. 34.
    Dueholm M, Lundorf E, Sørensen JS, Ledertoug S, Olesen F, Laursen H. Reproducibility of evaluation of the uterus by transvaginal sonography, hysterosonographic examination, hysteroscopy and magnetic resonance imaging. Hum Reprod. 2002;17(1):195–200.PubMedGoogle Scholar
  35. 35.
    Dueholm M, Lundorf E, Hansen ES, Ledertoug S, Olesen F. Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas. Am J Obstet Gynecol. 2002;186(3):409–15.PubMedGoogle Scholar
  36. 36.
    Fedele L, Bianchi S, Dorta M, Brioschi D, Zanotti F, Vercellini P. Transvaginal ultrasonography versus hysteroscopy in the diagnosis of uterine submucous myomas. Obstet Gynecol. 1991;77(5):745–8.PubMedGoogle Scholar
  37. 37.
    Vitiello D, McCarthy S. Diagnostic imaging of myomas. Obstet Gynecol Clin North Am. 2006;33(1):85–95.PubMedGoogle Scholar
  38. 38.
    Fayez JA, Mutie G, Schneider PJ. The diagnostic value of hysterosalpingography and hysteroscopy in infertility investigation. Am J Obstet Gynecol. 1987;156(3):558–60.PubMedGoogle Scholar
  39. 39.
    Cicinelli E, Romano F, Anastasio PS, Blasi N, Parisi C. Sonohysterography versus hysteroscopy in the diagnosis of endouterine polyps. Gynecol Obstet Invest. 1994;38(4):266–71.PubMedGoogle Scholar
  40. 40.
    Somigliana E, Vercellini P, Daguati R, Pasin R, De Giorgi O, Crosignani PG. Fibroids and female reproduction: a critical analysis of the evidence. Hum Reprod Update. 2007;13(5):465–76.PubMedGoogle Scholar
  41. 41.
    Wamsteker K, Emanuel MH, de Kruif JH. Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: results regarding the degree of intramural extension. Obstet Gynecol. 1993;82(5):736–40.PubMedGoogle Scholar
  42. 42.
    Bajekal N, Li TC. Fibroids, infertility and pregnancy wastage. Hum Reprod Update. 2000;6(6):614–20.PubMedGoogle Scholar
  43. 43.
    Wallach EE, Vu KK. Myomata uteri and infertility. Obstet Gynecol Clin North Am. 1995;22(4):791–9.PubMedGoogle Scholar
  44. 44.
    Khaund A, Lumsden MA. Impact of fibroids on reproductive function. Best Pract Res Clin Obstet Gynaecol. 2008;22(4):749–60.PubMedGoogle Scholar
  45. 45.
    Vercellini P, Maddalena S, De Giorgi O, Aimi G, Crosignani PG. Abdominal myomectomy for infertility: a comprehensive review. Hum Reprod. 1998;13(4):873–9.PubMedGoogle Scholar
  46. 46.
    Klatsky PC, Tran ND, Caughey AB, Fujimoto VY. Fibroids and reproductive outcomes: a systematic literature review from conception to delivery. Am J Obstet Gynecol. 2008;198(4):357–66.PubMedGoogle Scholar
  47. 47.
    Cook H, Ezzati M, Segars JH, McCarthy K. The impact of uterine leiomyomas on reproductive outcomes. Minerva Ginecol. 2010;62(3):225–36.PubMedCentralPubMedGoogle Scholar
  48. 48.
    Iosif CS, Akerlund M. Fibromyomas and uterine activity. Acta Obstet Gynecol Scand. 1983;62(2):165–7.PubMedGoogle Scholar
  49. 49.
    Ng EH, Chan CC, Tang OS, Yeung WS, Ho PC. Endometrial and subendometrial blood flow measured by three-dimensional power Doppler ultrasound in patients with small intramural uterine fibroids during IVF treatment. Hum Reprod. 2005;20(2):501–6.PubMedGoogle Scholar
  50. 50.
    Hunt JE, Wallach EE. Uterine factors in infertility–an overview. Clin Obstet Gynecol. 1974;17(4):44–64.PubMedGoogle Scholar
  51. 51.
    Nishino M, Togashi K, Nakai A, et al. Uterine contractions evaluated on cine MR imaging in patients with uterine leiomyomas. Eur J Radiol. 2005;53(1):142–6.PubMedGoogle Scholar
  52. 52.
    Vollenhoven BJ, Lawrence AS, Healy DL. Uterine fibroids: a clinical review. Br J Obstet Gynaecol. 1990;97(4):285–98.PubMedGoogle Scholar
  53. 53.
    Richards PA, Richards PD, Tiltman AJ. The ultrastructure of fibromyomatous myometrium and its relationship to infertility. Hum Reprod Update. 1998;4(5):520–5.PubMedGoogle Scholar
  54. 54.
    Ng EH, Ho PC. Doppler ultrasound examination of uterine arteries on the day of oocyte retrieval in patients with uterine fibroids undergoing IVF. Hum Reprod. 2002;17(3):765–70.PubMedGoogle Scholar
  55. 55.
    Dickey RP. Doppler ultrasound investigation of uterine and ovarian blood flow in infertility and early pregnancy. Hum Reprod Update. 1997;3(5):467–503.PubMedGoogle Scholar
  56. 56.
    Hasan F, Arumugam K, Sivanesaratnam V. Uterine leiomyomata in pregnancy. Int J Gynaecol Obstet. 1991;34(1):45–8.PubMedGoogle Scholar
  57. 57.
    Verkauf BS. Myomectomy for fertility enhancement and preservation. Fertil Steril. 1992;58(1):1–15.PubMedGoogle Scholar
  58. 58.
    Deligdish L, Loewenthal M. Endometrial changes associated with myomata of the uterus. J Clin Pathol. 1970;23(8):676–80.PubMedCentralPubMedGoogle Scholar
  59. 59.
    Forssman L. Blood flow in myomatous uteri as measured by intra-arterial 133Xenon. Acta Obstet Gynecol Scand. 1976;55(1):21–4.PubMedGoogle Scholar
  60. 60.
    Oliveira FG, Abdelmassih VG, Diamond MP, Dozortsev D, Melo NR, Abdelmassih R. Impact of subserosal and intramural uterine fibroids that do not distort the endometrial cavity on the outcome of in vitro fertilization-intracytoplasmic sperm injection. Fertil Steril. 2004;81(3):582–7.PubMedGoogle Scholar
  61. 61.
    Somigliana E, De Benedictis S, Vercellini P, et al. Fibroids not encroaching the endometrial cavity and IVF success rate: a prospective study. Hum Reprod. 2011;26(4):834–9.PubMedGoogle Scholar
  62. 62.
    Donnez J, Jadoul P. What are the implications of myomas on fertility? A need for a debate? Hum Reprod. 2002;17(6):1424–30.PubMedGoogle Scholar
  63. 63.
    Pritts EA, Parker WH, Olive DL. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril. 2009;91(4):1215–23.PubMedGoogle Scholar
  64. 64.
    Sunkara SK, Khairy M, El-Toukhy T, Khalaf Y, Coomarasamy A. The effect of intramural fibroids without uterine cavity involvement on the outcome of IVF treatment: a systematic review and meta-analysis. Hum Reprod. 2010;25(2):418–29.PubMedGoogle Scholar
  65. 65.
    Ubaldi F, Tournaye H, Camus M, Van der Pas H, Gepts E, Devroey P. Fertility after hysteroscopic myomectomy. Hum Reprod Update. 1995;1(1):81–90.PubMedGoogle Scholar
  66. 66.
    Pritts EA. Fibroids and infertility: a systematic review of the evidence. Obstet Gynecol Surv. 2001;56(8):483–91.PubMedGoogle Scholar
  67. 67.
    Rackow BW, Taylor HS. Submucosal uterine leiomyomas have a global effect on molecular determinants of endometrial receptivity. Fertil Steril. 2010;93(6):2027–34.PubMedCentralPubMedGoogle Scholar
  68. 68.
    Rackow BW, Arici A. Options for medical treatment of myomas. Obstet Gynecol Clin North Am. 2006;33(1):97–113.PubMedGoogle Scholar
  69. 69.
    Rackow BW, Arici A. Fibroids and in-vitro fertilization: which comes first? Curr Opin Obstet Gynecol. 2005;17(3):225–31.PubMedGoogle Scholar
  70. 70.
    Stovall DW, Parrish SB, Van Voorhis BJ, Hahn SJ, Sparks AE, Syrop CH. Uterine leiomyomas reduce the efficacy of assisted reproduction cycles: results of a matched follow-up study. Hum Reprod. 1998;13(1):192–7.PubMedGoogle Scholar
  71. 71.
    Bernard G, Darai E, Poncelet C, Benifla JL, Madelenat P. Fertility after hysteroscopic myomectomy: effect of intramural myomas associated. Eur J Obstet Gynecol Reprod Biol. 2000;88(1):85–90.PubMedGoogle Scholar
  72. 72.
    Hart R, Khalaf Y, Yeong CT, Seed P, Taylor A, Braude P. A prospective controlled study of the effect of intramural uterine fibroids on the outcome of assisted conception. Hum Reprod. 2001;16(11):2411–7.PubMedGoogle Scholar
  73. 73.
    Li TC, Mortimer R, Cooke ID. Myomectomy: a retrospective study to examine reproductive performance before and after surgery. Hum Reprod. 1999;14(7):1735–40.PubMedGoogle Scholar
  74. 74.
    Farhi J, Ashkenazi J, Feldberg D, Dicker D, Orvieto R, Ben Rafael Z. Effect of uterine leiomyomata on the results of in-vitro fertilization treatment. Hum Reprod. 1995;10(10):2576–8.PubMedGoogle Scholar
  75. 75.
    Eldar-Geva T, Meagher S, Healy DL, MacLachlan V, Breheny S, Wood C. Effect of intramural, subserosal, and submucosal uterine fibroids on the outcome of assisted reproductive technology treatment. Fertil Steril. 1998;70(4):687–91.PubMedGoogle Scholar
  76. 76.
    Narayan R, Rajat, Goswamy K. Treatment of submucous fibroids, and outcome of assisted conception. J Am Assoc Gynecol Laparosc. 1994;1(4 Pt 1):307–11.Google Scholar
  77. 77.
    Varasteh NN, Neuwirth RS, Levin B, Keltz MD. Pregnancy rates after hysteroscopic polypectomy and myomectomy in infertile women. Obstet Gynecol. 1999;94(2):168–71.PubMedGoogle Scholar
  78. 78.
    Surrey ES, Minjarez DA, Stevens JM, Schoolcraft WB. Effect of myomectomy on the outcome of assisted reproductive technologies. Fertil Steril. 2005;83(5):1473–9.PubMedGoogle Scholar
  79. 79.
    Gambadauro P. Dealing with uterine fibroids in reproductive medicine. J Obstet Gynaecol. 2012;32(3):210–6.PubMedGoogle Scholar
  80. 80.
    Shozu M, Sumitani H, Segawa T, Yang HJ, Murakami K, Inoue M. Inhibition of in situ expression of aromatase P450 in leiomyoma of the uterus by leuprorelin acetate. J Clin Endocrinol Metab. 2001;86(11):5405–11.PubMedGoogle Scholar
  81. 81.
    Friedman AJ, Hoffman DI, Comite F, Browneller RW, Miller JD. Treatment of leiomyomata uteri with leuprolide acetate depot: a double-blind, placebo-controlled, multicenter study. The Leuprolide Study Group. Obstet Gynecol. 1991;77(5):720–5.PubMedGoogle Scholar
  82. 82.
    Mettler L, Alvarez-Rodas E, Semm K. Hormonal treatment and pelviscopic myomectomy. Diagn Ther Endosc. 1995;1(4):217–21.PubMedCentralPubMedGoogle Scholar
  83. 83.
    De Falco M, Staibano S, Mascolo M, et al. Leiomyoma pseudocapsule after pre-surgical treatment with gonadotropin-releasing hormone agonists: relationship between clinical features and immunohistochemical changes. Eur J Obstet Gynecol Reprod Biol. 2009;144(1):44–7.PubMedGoogle Scholar
  84. 84.
    Olive DL, Lindheim SR, Pritts EA. Non-surgical management of leiomyoma: impact on fertility. Curr Opin Obstet Gynecol. 2004;16(3):239–43.PubMedGoogle Scholar
  85. 85.
    Donnez J, Tatarchuk TF, Bouchard P, et al. Ulipristal acetate versus placebo for fibroid treatment before surgery. N Engl J Med. 2012;366(5):409–20.PubMedGoogle Scholar
  86. 86.
    Donnez J, Tomaszewski J, Vázquez F, et al. Ulipristal acetate versus leuprolide acetate for uterine fibroids. N Engl J Med. 2012;366(5):421–32.PubMedGoogle Scholar
  87. 87.
    Gurates B, Parmaksiz C, Kilic G, Celik H, Kumru S, Simsek M. Treatment of symptomatic uterine leiomyoma with letrozole. Reprod Biomed Online. 2008;17(4):569–74.PubMedGoogle Scholar
  88. 88.
    Parsanezhad ME, Azmoon M, Alborzi S, et al. A randomized, controlled clinical trial comparing the effects of aromatase inhibitor (letrozole) and gonadotropin-releasing hormone agonist (triptorelin) on uterine leiomyoma volume and hormonal status. Fertil Steril. 2010;93(1):192–8.PubMedGoogle Scholar
  89. 89.
    Song H, Lu D, Navaratnam K, Shi G. Aromatase inhibitors for uterine fibroids. Cochrane Database Syst Rev. 2013;(10):CD009505.Google Scholar
  90. 90.
    Advincula AP, Song A. Endoscopic management of leiomyomata. Semin Reprod Med. 2004;22(2):149–55.PubMedGoogle Scholar
  91. 91.
    Advincula AP, Xu X, Goudeau S, Ransom SB. Robot-assisted laparoscopic myomectomy versus abdominal myomectomy: a comparison of short-term surgical outcomes and immediate costs. J Minim Invasive Gynecol. 2007;14(6):698–705.PubMedGoogle Scholar
  92. 92.
    Advincula AP, Song A, Burke W, Reynolds RK. Preliminary experience with robot-assisted laparoscopic myomectomy. J Am Assoc Gynecol Laparosc. 2004;11(4):511–8.PubMedGoogle Scholar
  93. 93.
    Payne TN, Pitter MC. Robotic-assisted surgery for the community gynecologist: can it be adopted? Clin Obstet Gynecol. 2011;54(3):391–411.PubMedGoogle Scholar
  94. 94.
    Lönnerfors C, Persson J. Robot-assisted laparoscopic myomectomy; a feasible technique for removal of unfavorably localized myomas. Acta Obstet Gynecol Scand. 2009;88(9):994–9.PubMedGoogle Scholar
  95. 95.
    Advincula AP, Song A. The role of robotic surgery in gynecology. Curr Opin Obstet Gynecol. 2007;19(4):331–6.PubMedGoogle Scholar
  96. 96.
    Barakat EE, Bedaiwy MA, Zimberg S, Nutter B, Nosseir M, Falcone T. Robotic-assisted, laparoscopic, and abdominal myomectomy: a comparison of surgical outcomes. Obstet Gynecol. 2011;117(2 Pt 1):256–65.PubMedGoogle Scholar
  97. 97.
    Ascher-Walsh CJ, Capes TL. Robot-assisted laparoscopic myomectomy is an improvement over laparotomy in women with a limited number of myomas. J Minim Invasive Gynecol. 2010;17(3):306–10.PubMedGoogle Scholar
  98. 98.
    Nezhat C, Lavie O, Hsu S, Watson J, Barnett O, Lemyre M. Robotic-assisted laparoscopic myomectomy compared with standard laparoscopic myomectomy–a retrospective matched control study. Fertil Steril. 2009;91(2):556–9.PubMedGoogle Scholar
  99. 99.
    Bedient CE, Magrina JF, Noble BN, Kho RM. Comparison of robotic and laparoscopic myomectomy. Am J Obstet Gynecol. 2009;201(6):566.e1–5.Google Scholar
  100. 100.
    Griffin L, Feinglass J, Garrett A, et al. Postoperative outcomes after robotic versus abdominal myomectomy. JSLS. 2013;17(3):407–13.PubMedCentralPubMedGoogle Scholar
  101. 101.
    Behera MA, Likes CE, Judd JP, Barnett JC, Havrilesky LJ, Wu JM. Cost analysis of abdominal, laparoscopic, and robotic-assisted myomectomies. J Minim Invasive Gynecol. 2012;19(1):52–7.PubMedGoogle Scholar
  102. 102.
    Nash K, Feinglass J, Zei C, et al. Robotic-assisted laparoscopic myomectomy versus abdominal myomectomy: a comparative analysis of surgical outcomes and costs. Arch Gynecol Obstet. 2012;285(2):435–40.PubMedGoogle Scholar
  103. 103.
    Saceanu SM, Cela V, Pluchino N, Angelescu C, Surlin V, Genazzani A. Robotic-assisted laparoscopic surgery in uterine pathology. Eur J Obstet Gynecol Reprod Biol. 2013;169(2):340–2.PubMedGoogle Scholar
  104. 104.
    Pundir J, Pundir V, Walavalkar R, Omanwa K, Lancaster G, Kayani S. Robotic-assisted laparoscopic vs abdominal and laparoscopic myomectomy: systematic review and meta-analysis. J Minim Invasive Gynecol. 2013;20(3):335–45.PubMedGoogle Scholar
  105. 105.
    Lönnerfors C, Persson J. Pregnancy following robot-assisted laparoscopic myomectomy in women with deep intramural myomas. Acta Obstet Gynecol Scand. 2011;90(9):972–7.PubMedGoogle Scholar
  106. 106.
    Pitter MC, Gargiulo AR, Bonaventura LM, Lehman JS, Srouji SS. Pregnancy outcomes following robot-assisted myomectomy. Hum Reprod. 2013;28(1):99–108.PubMedGoogle Scholar
  107. 107.
    Liu H, Lu D, Wang L, Shi G, Song H, Clarke J. Robotic surgery for benign gynaecological disease. Cochrane Database Syst Rev. 2012;(2):CD008978.Google Scholar
  108. 108.
    Parker WH. Uterine myomas: management. Fertil Steril. 2007;88(2):255–71.PubMedGoogle Scholar
  109. 109.
    Walker WJ, McDowell SJ. Pregnancy after uterine artery embolization for leiomyomata: a series of 56 completed pregnancies. Am J Obstet Gynecol. 2006;195(5):1266–71.PubMedGoogle Scholar
  110. 110.
    Tropeano G, Amoroso S, Scambia G. Non-surgical management of uterine fibroids. Hum Reprod Update. 2008;14(3):259–74.PubMedGoogle Scholar
  111. 111.
    Gupta JK, Sinha AS, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. 2006;(1):CD005073.Google Scholar
  112. 112.
    Gupta JK, Sinha A, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. 2012;5:CD005073.Google Scholar
  113. 113.
    Zreik TG, Rutherford TJ, Palter SF, et al. Cryomyolysis, a new procedure for the conservative treatment of uterine fibroids. J Am Assoc Gynecol Laparosc. 1998;5(1):33–8.PubMedGoogle Scholar
  114. 114.
    Rutherford TJ, Zreik TG, Troiano RN, Palter SF, Olive DL. Endometrial cryoablation, a minimally invasive procedure for abnormal uterine bleeding. J Am Assoc Gynecol Laparosc. 1998;5(1):23–8.PubMedGoogle Scholar
  115. 115.
    Ciavattini A, Tsiroglou D, Piccioni M, et al. Laparoscopic cryomyolysis: an alternative to myomectomy in women with symptomatic fibroids. Surg Endosc. 2004;18(12):1785–8.PubMedGoogle Scholar
  116. 116.
    Zupi E, Piredda A, Marconi D, et al. Directed laparoscopic cryomyolysis: a possible alternative to myomectomy and/or hysterectomy for symptomatic leiomyomas. Am J Obstet Gynecol. 2004;190(3):639–43.PubMedGoogle Scholar
  117. 117.
    Zupi E, Sbracia M, Marconi D, Munro MG. Myolysis of uterine fibroids: is there a role? Clin Obstet Gynecol. 2006;49(4):821–33.PubMedGoogle Scholar
  118. 118.
    Simonetti G, Romanini C, Pocek M, et al. Embolization of the uterine artery in the treatment of uterine myoma. Radiol Med. 2001;101(3):157–64.PubMedGoogle Scholar
  119. 119.
    Ciavattini A, Tsiroglou D, Litta P, Vichi M, Tranquilli AL. Pregnancy outcome after laparoscopic cryomyolysis of uterine myomas: report of nine cases. J Minim Invasive Gynecol. 2006;13(2):141–4.PubMedGoogle Scholar
  120. 120.
    Rabinovici J, David M, Fukunishi H, et al. Pregnancy outcome after magnetic resonance-guided focused ultrasound surgery (MRgFUS) for conservative treatment of uterine fibroids. Fertil Steril. 2010;93(1):199–209.PubMedGoogle Scholar
  121. 121.
    Bouwsma EV, Gorny KR, Hesley GK, Jensen JR, Peterson LG, Stewart EA. Magnetic resonance-guided focused ultrasound surgery for leiomyoma-associated infertility. Fertil Steril. 2011;96(1):e9–12.PubMedGoogle Scholar
  122. 122.
    Stewart EA, Rabinovici J, Tempany CM, et al. Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids. Fertil Steril. 2006;85(1):22–9.PubMedGoogle Scholar
  123. 123.
    Stewart EA, Gedroyc WM, Tempany CM, et al. Focused ultrasound treatment of uterine fibroid tumors: safety and feasibility of a noninvasive thermoablative technique. Am J Obstet Gynecol. 2003;189(1):48–54.PubMedGoogle Scholar
  124. 124.
    Machtinger R, Inbar Y, Cohen-Eylon S, Admon D, Alagem-Mizrachi A, Rabinovici J. MR-guided focus ultrasound (MRgFUS) for symptomatic uterine fibroids: predictors of treatment success. Hum Reprod. 2012;27(12):3425–31.PubMedGoogle Scholar
  125. 125.
    Hindley J, Gedroyc WM, Regan L, et al. MRI guidance of focused ultrasound therapy of uterine fibroids: early results. AJR Am J Roentgenol. 2004;183(6):1713–9.PubMedGoogle Scholar
  126. 126.
    Chang KM, Chen MJ, Lee MH, Huang YD, Chen CS. Fertility and pregnancy outcomes after uterine artery occlusion with or without myomectomy. Taiwan J Obstet Gynecol. 2012;51(3):331–5.PubMedGoogle Scholar
  127. 127.
    Park KH, Kim JY, Shin JS, et al. Treatment outcomes of uterine artery embolization and laparoscopic uterine artery ligation for uterine myoma. Yonsei Med J. 2003;44(4):694–702.PubMedGoogle Scholar
  128. 128.
    Nyapathy V, Polina L. MRgFUS treatment of uterine fibroid in a nulliparous woman with acute retention of urine. J Radiol Case Rep. 2012;6(2):1–8.PubMedCentralPubMedGoogle Scholar
  129. 129.
    Funaki K, Fukunishi H, Sawada K. Clinical outcomes of magnetic resonance-guided focused ultrasound surgery for uterine myomas: 24-month follow-up. Ultrasound Obstet Gynecol. 2009;34(5):584–9.PubMedGoogle Scholar
  130. 130.
    Fukunishi H, Funaki K, Sawada K, Yamaguchi K, Maeda T, Kaji Y. Early results of magnetic resonance-guided focused ultrasound surgery of adenomyosis: analysis of 20 cases. J Minim Invasive Gynecol. 2008;15(5):571–9.PubMedGoogle Scholar
  131. 131.
    Gorny KR, Woodrum DA, Brown DL, et al. Magnetic resonance-guided focused ultrasound of uterine leiomyomas: review of a 12-month outcome of 130 clinical patients. J Vasc Interv Radiol. 2011;22(6):857–64.PubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Leeds Centre for Reproductive Medicine, Department of Obstetrics and GynaecologyLeeds Teaching Hospitals NHS TrustLeedsUK
  2. 2.Department of Obstetrics and GynaecologySheffield Teaching Hospital NHS Foundation TrustSheffieldUK

Personalised recommendations