title: The effect of intramural fibroids without uterine cavity involvement on the outcome of IVF treatment: a systematic review and meta-analysis.
abstract: BACKGROUND
  The influence of fibroids on fertility is poorly understood. Submucosal and intramural fibroids that distort the endometrial cavity have been associated with decreased pregnancy rates (PRs) following IVF treatment. However, there is uncertainty about the effect of intramural fibroids that do not distort the endometrial cavity on IVF outcomes.
  
  
  METHODS
  We conducted a systematic review and meta-analysis of studies to evaluate the association between non-cavity-distorting intramural fibroids and IVF outcome. Searches were conducted on MEDLINE, EMBASE, Cochrane Library and Web of Science. Study selection and data extraction were conducted independently by two reviewers. The Newcastle-Ottawa Quality Assessment Scales were used for quality assessment. Meta-analysis was performed if appropriate.
  
  
  RESULTS
  We identified 19 observational studies comprising 6087 IVF cycles. Meta-analysis of these studies showed a significant decrease in the live birth (RR = 0.79, 95% CI: 0.70-0.88, P < 0.0001) and clinical PRs (RR = 0.85, 95% CI: 0.77-0.94, P = 0.002) in women with non-cavity-distorting intramural fibroids compared with those without fibroids, following IVF treatment.
  
  
  CONCLUSIONS
  The presence of non-cavity-distorting intramural fibroids is associated with adverse pregnancy outcomes in women undergoing IVF treatment.
authors.affiliation: Assisted Conception Unit, Guy's and St Thomas' Hospitals NHS Foundation Trust, 11th Floor, Tower Wing, Guy's Hospital Great Maze Pond, London SE1 9RT, UK. sksunkara@hotmail.com
authors.forename: Sesh Kamal
authors.initials: SK
authors.lastname: Sunkara
authors.forename: Mohammed
authors.initials: M
authors.lastname: Khairy
authors.forename: Tarek
authors.initials: T
authors.lastname: El-Toukhy
authors.forename: Yacoub
authors.initials: Y
authors.lastname: Khalaf
authors.forename: Arri
authors.initials: A
authors.lastname: Coomarasamy
mesh_terms: D010064:Embryo Implantation; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D006801:Humans; D007889:Leiomyoma / Q000150:complications*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D014594:Uterine Neoplasms / Q000150:complications*