Key Points

• Leiomyomas have been related to infertility and recurrent pregnancy loss but the mechanisms are still not clearly defined.
• The available evidence suggests that sub mucous myomas alter endometrial molecular expressions associated with receptivity to embryo attachment and implantation.
• There is also evidence that leiomyomas may alter myometrial contractility in a fashion that adversely impacts sperm transport.
• The available evidence suggests that sub mucous tumors (Types 0, 1, 2, & 2-5) likely increase the risk of infertility, and, when removed, appear to improve fertility.
• It appears that subserous fibroids (FIGO Types 5, 6, & 7) are generally unrelated to fertility - their removal appears to have no impact on fertility outcomes.
• The role of Type 4 tumors is controversial and evidence variable, with myomectomy generally not associated with improved fertility.
• There is emerging evidence that FIGO Type 3 tumors may significantly reduce implantation, pregnancy, and delivery rates in infertile individuals. However, evidence showing post-myomectomy improvement pregnancy outcomes following embryo transfer is currently lacking.
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Requirements for fertility - Physiology

• Background on fertility requirements
• Male factor, uterine factors (cervical, myometrial, endometrial), tubal, ovarian, ovulatory (hypo-pit-ovarian axis)

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How leiomyomas may impact fertility and early pregnancy - Pathophysiology

• Background on fertility requirements.
• What is infertility?
• Adverse impact on endometrial receptivity.
• Potential adverse impact on myometrial contractility.
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