Chadi Yazbeck: Fibroids and Infertility – Do You Really Need Surgery?
Chadi Yazbeck, Clinical Coordinator at the Assisted Reproductive Technology (ART) Center at Ambroise Paré – Hartmann Private Hospital Group and President of the Fertility Study Group in France (GEFF), shared on LinkedIn:
”Fibroids and infertility: do you really need surgery?
I had the pleasure of presenting at the INFOGYN congress a synthesis on the management of fibroids in infertile women and women undergoing ART.
An important finding: despite an abundant literature, meta-analyses are still largely based on observational studies of low-level evidence.
Some practical messages to remember:
- FIGO fibroids 0–1–2:
They have a proven adverse impact on fertility. Their hysteroscopic resection remains the consensus surgical indication.
- FIGO 3 fibroids: a special situation
Their management probably deserves to be individualized, especially from 2cm.
- Non-deforming FIGO 4–5 fibroids
Their impact on fertility is much less certain. There is no sufficient argument to suggest a systematic myomectomy solely for the purpose of improving fertility. Size, location, track record and failures of ART must be taken into the decision.
Preserving fertility also means mastering the surgical gesture.
Protect the cavity and endometrium, limit the energy used and the risk of adhesions, and offer a follow-up hysteroscopy when necessary. Uterine artery embolization should be avoided when a future pregnancy is desired, in accordance with current recommendations.
The essential message: not all fibroids need to be operated on.
Reasoned and individualized care therefore remains at the heart of the medical-surgical decision!”
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