A 30-year-old nulliparous woman with primary infertility is found to have a 5 cm intramural fibroid (FIGO Type 4) distorting the endometrial cavity on hysteroscopy. Which statement best describes the evidence regarding this fibroid's impact on fertility?
- A Intramural fibroids have no impact on fertility regardless of size
- B Only submucous fibroids impair fertility; intramural fibroids do not
- C Intramural fibroids that distort the cavity reduce implantation rates and myomectomy may improve outcomes ✓
- D All intramural fibroids require removal before attempting conception
Correct answer: C. Intramural fibroids that distort the cavity reduce implantation rates and myomectomy may improve outcomes
Explanation
Submucous fibroids clearly impair fertility and miscarriage rates, and hysteroscopic removal improves outcomes. Intramural fibroids that distort the endometrial cavity or are larger than 4 to 5 cm may also reduce implantation and pregnancy rates. The ESHRE and ACOG guidelines suggest considering myomectomy for cavity-distorting intramural fibroids in women with otherwise unexplained infertility.
Reference: Te Linde's Operative Gynecology, 12th ed.
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