Physician Management of Non-Cavity Distorting Intramural Fibroids and Infertility: A Survey of REI Providers.

PURPOSE: Uterine fibroids commonly impact women of reproductive age, with the submucosal subtype known to adversely affect fertility. Recently, non-cavity distorting intramural fibroids have been found to impair the uterine environment leading many reproductive endocrinologists to surgically remove these fibroids prior to infertility treatment. However, the frequency with which this intervention occurs in actual practice remains in question.

PATIENTS AND METHODS: A database of 407 US-based reproductive endocrinology and infertility (REI) clinics was synthesized from the Centers for Disease Control & Prevention National ART Surveillance System and the Society for Assisted Reproductive Technology's Clinic List. Medical directors at each site were invited to complete a REDCap-administered cross-sectional survey on management of non-cavity distorting intramural fibroids in patients pursuing infertility treatment.

RESULTS: A total of 112 (28%) REI physicians completed the survey, representing a variety of clinic settings, locations, and volumes. The majority of respondents (72%) consider surgical management of non-cavity distorting intramural fibroids based on factors such as size, with myomas 4.1-6 cm or larger more likely to be considered for removal. Approximately 42% of REI physician respondents surgically remove non-cavity distorting intramural fibroids themselves, while 58% refer to other gynecologic surgeons.

CONCLUSION: Many physicians consider the removal of non-cavity distorting intramural fibroids prior to infertility treatment. Additional research is needed to better understand the indications for surgical management of various fibroid subtypes and the true scope of removal in current practice.