O-257 The effect of the presence of intramural myomas smaller than 6 cm on reproductive outcome in IVF treatment: a systematic review and meta-analysis
Notice bibliographique
Résumé
Abstract Study question What is the effect of small intramural myomas on the reproductive outcome of in vitro fertilization (IVF) treatment? Summary answer Non-cavity-distorting intramural myomas with the size of < 6 cm have a significant adverse effect on reproductive outcomes in IVF treatment. What is known already There is a consensus that submucous myomas have a significant unfavorable impact on reproductive outcomes, whereas subserosal myomas do not seem to have any adverse effects. Women with large (≥6 cm) non-cavity-distorting intramural myomas should be evaluated individually, considering their reproductive history. However, there is scarce data on the effect of relatively smaller intramural myomas (<6 cm) on reproductive outcomes and how to manage them before IVF treatment. Study design, size, duration This study is a systematic review and meta-analysis according to PRISMA guidelines. We performed a comprehensive search of PubMed, Web of Science, and Cochrane Library databases to identify relevant studies from inception until 31 November 2021. Search terms were used as “intramural fibroid*” [tw] OR “intramural leiomyom*” [tw] OR “intramural myom*” [tw]. English language and human subjects were applied to search filters. Participants/materials, setting, methods The target population was infertile women undergoing IVF treatment with non-cavity-distorting intramural myomas <6 cm in diameter. History of myomectomy and the presence of predominant subserous myomas, submucous myomas, or other cavity distorting pathologies were exclusion criteria. The primary outcome measures were live birth rate (LBR) and miscarriage rate (MR). Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of included studies. All statistical analyses were performed using RevMan 5.4.1. Main results and the role of chance The initial search strategy yielded 378 studies. After adopting exclusion criteria, eight studies were included in the final analysis. Six of these studies had a NOS score of 8 out of 10, and the remaining two studies had 9 out of 10. Three studies had a prospective design, and five studies had a retrospective design. Two of eight studies did not report LBR as an outcome. In pooling data analysis of six studies including 2058 cycles (1980 women), 41% relative reduction in LBR was observed in women with non-cavity-distorting intramural myomas with the size of < 6 cm compared to women without myomas (RR = 0.59, 95%CI: 0.49–0.71, I2=0%, p<0.00001). A sub-group analysis for smaller intramural myomas (<3 cm) was also performed and concordantly 27% decrease in the LBR (RR = 0.73, 95% CI: 0.57–0.93, I2=0%, p=0.01) was found. Regarding the MR, for women with non-cavity-distorting intramural myomas with the size of < 6 cm, 50% relative increase in MR was found when compared with women without myomas (RR = 1.50, 95%CI: 1.11–2.04, I2=0%, 8 studies, p=0.009). Limitations, reasons for caution Lack of information regarding the distance of myomas from endometrium and the number of myomas in most of the included studies is a limitation. Differences in IVF treatment and uterine cavity evaluation methods among studies may limit generalizability of the findings. Future RCTs are warranted to confirm our findings. Wider implications of the findings This study is the first meta-analysis with overall moderate-quality evidence from observational studies to demonstrate the adverse effect of the presence of small (<6 cm) intramural myomas on reproductive outcomes in IVF treatment. Surgical removal of such small myomas should be considered before IVF treatment. Trial registration number not applicable
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,007 | 0,003 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».