| Fibroids in infertility - consensus statement from ACCEPT (Australasian CREI Consensus Expert Panel on Trial evidence). | |
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MedLine Citation:
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PMID: 21806566 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Fibroid management is surrounded by considerable controversy and uncertainty. This paper summarises the consensus developed by a group of Australasian subspecialists in reproductive endocrinology and infertility (the ACCEPT group) on the evidence concerning the impact and management of fibroids in infertility. The location of a fibroid within the uterus influences its effect on fertility. Subserosal fibroids do not appear to impact on fertility outcomes. Intramural (IM) fibroids may be associated with reduced fertility and an increased miscarriage rate (MR); however, there is insufficient evidence to inform whether myomectomy for IM fibroids improves fertility outcomes. Submucosal fibroids are associated with reduced fertility and an increased MR, and myomectomy for submucosal fibroids appears likely to improve fertility outcomes. The relative effect of multiple or different sized fibroids on fertility outcomes is uncertain, as is the relative usefulness of myomectomy in these situations. It is recommended that fibroids with suspected cavity involvement are defined by magnetic resonance imaging, sonohysterography or hysteroscopy because modalities such as transvaginal ultrasound and hysterosalpingography lack appropriate sensitivity and specificity. Medical management of fibroids delays efforts to conceive and is not recommended for the management of infertility associated with fibroids. Newer treatments such as uterine artery embolisation, radiofrequency ablation, bilateral uterine artery ligation, magnetic resonance-guided focussed ultrasound surgery and fibroid myolysis require further investigation prior to their establishment in the routine management of fibroid-associated infertility. |
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Authors:
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Ben Kroon; Neil Johnson; Michael Chapman; Anusch Yazdani; Roger Hart; |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-3-22 |
Journal Detail:
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Title: The Australian & New Zealand journal of obstetrics & gynaecology Volume: - ISSN: 1479-828X ISO Abbreviation: - Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-8-2 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0001027 Medline TA: Aust N Z J Obstet Gynaecol Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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© 2011 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology © 2011 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. |
Affiliation:
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Queensland Fertility Group Research Foundation Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia Fertility Plus, Auckland District Health Board University of Auckland, Auckland, New Zealand Women's and Children's Health, University of New South Wales IVF Australia, Sydney, New South Wales School of Women's and Infants' Health, The University of Western Australia Fertility Specialists of Western Australia, Perth, Western Australia, Australia. |
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