Cine MRI can be an effective tool to determine surgical indication for uterine fibroids in infertile women

Intramural fibroids seem to cause an adverse effect for infertile women, but it is controversial whether myomectomy should be performed or not, especially for intramural fibroids without distortion of the uterine cavity. It is reported that uterine peristalsis during implantation phase might be associated with infertility and myomectomy may improve pregnancy outcome. Our aim is to evaluate the effectiveness of cine MRI about uterine peristalsis for choosing a treatment approach to uterine fibroids for infertile women. Non-randomized Controlled study. Informed consents were obtained from all patients in every procedure such as MRI and operations. Sixty-two infertile patients with uterine fibroids were examined using cine MRI between October 2010 and August 2015. Eligibility criteria were intramural fibroid without distortion or elongation to the endometrial cavity. Cine MRI was performed at mid-luteal phase. Women who had 2 or more times of junctional zone movement within 3 minutes (uterine peristalsis, P+ group) were referred for myomectomy and infertility treatments were undergone after surgery. Women with 0 or 1 time of uterine peristalsis (P- group) were managed expectantly about fibroids and received infertility treatments at first. Serum estrogen and progesterone levels were measured on the day of cine MRI and pregnancy rate was evaluated prospectively. Student's t-test and chi-squared test were used for statistical analysis of hormone levels and pregnancy rates. Among 62 patients, 35(56.5%) and 27(43.5%) were assigned to the P+ or P- group, respectively. No significant differences were observed in serum estrogen and progesterone levels between the two groups (235.4±114.4pg/ml and 12.6±5.2ng/ml v.s. 198.2±68.6pg/ml and 15.4±4.1ng/ml). Fifteen out of 26 patients (57.7%) in the P- group without myomectomy achieved pregnancy. In the P+ group, 16 out of 23 patients with myomectomy (69.6%) conceived, compared with 2 out of 8 patients without myomectomy (25.0%). Myomectomy tented to increase pregnancy rate (χ2=3.76, P=0.05). In addition, uterine peristalsis became disappeared or reduced in all 8 patients who checked secondary cine MRI after myomectomy in the P+ group. Our study showed cine MRI could identify surgical indication and improve pregnancy rate in patients who had uterine peristalsis caused by intramural fibroids. Thus, establishment of treatment strategy for fibroids could be expected as part of infertility treatment and cine MRI may be a useful tool to evaluate the pathology of fibroid and the effect of myomectomy.Tabled 1The analysis of cine MRI and pregnancy ratecine MRItreatment optionpreg-nancy (N)preg-nancy (%)no pregnancy (N)no pregnancy (%)uterine peristalsis(+)myomectomy1669.6%730.4%uterine peristalsis(+)no intervention225%675%uterine peristalsis(-)no intervention1557.7%1142.3% Open table in a new tab