title: Decreased pregnancy rate is linked to abnormal uterine peristalsis caused by intramural fibroids.
abstract: BACKGROUND
  The relationship between fibroids and infertility remains an unsolved question, and management of intramural fibroids is controversial. During the implantation phase, uterine peristalsis is dramatically reduced, which is thought to facilitate embryo implantation. Our aims were to evaluate (i) the occurrence and frequency of uterine peristalsis in infertile women with intramural fibroids and (ii) whether the presence of uterine peristalsis decreases the pregnancy rate.
  
  
  METHODS
  Ninety-five infertile patients with uterine fibroids were examined using magnetic resonance imaging (MRI). Inclusion criteria were as follows: (i) presence of intramural fibroids, excluding submucosal type; (ii) no other significant infertility factors (excluding endometriosis); and (iii) regular menstrual cycles, and MRI performed at the time of implantation (luteal phase day 5-9). The frequency of junctional zone movement was evaluated using cine-mode-display MRI. After MRI, patients underwent infertility treatment for up to 4 months, and the pregnancy rate was evaluated prospectively.
  
  
  RESULTS
  Fifty-one patients fulfilled the inclusion criteria, and 29 (57%) and 22 (43%) patients were assigned to the low (0 or 1 time/3 min) or high frequency (≥ 2 times/3 min) uterine peristalsis group, respectively. Endometriosis incidence was the same in both groups. Ten out of the 29 patients (34%) in the low-frequency group achieved pregnancy, compared with none of the 22 patients (0%) in the high-frequency group (P< 0.005). Comparing pregnant and non-pregnant cases, 4 of 10 patients (40%) and 9 of 41 patients (22%), respectively, had endometriosis (not significant).
  
  
  CONCLUSIONS
  A higher frequency of uterine peristalsis during the mid-luteal phase might be one of the causes of infertility associated with intramural-type fibroids.
authors: Department of Obstetrics and Gynecology, University of Tokyo, Tokyo 113-8655, Japan. oyoshino624@hotmail.co.jp
authors: O
authors: O
authors: Yoshino
authors: T
authors: T
authors: Hayashi
authors: Y
authors: Y
authors: Osuga
authors: M
authors: M
authors: Orisaka
authors: H
authors: H
authors: Asada
authors: S
authors: S
authors: Okuda
authors: M
authors: M
authors: Hori
authors: M
authors: M
authors: Furuya
authors: H
authors: H
authors: Onuki
authors: Y
authors: Y
authors: Sadoshima
authors: H
authors: H
authors: Hiroi
authors: T
authors: T
authors: Fujiwara
authors: F
authors: F
authors: Kotsuji
authors: Y
authors: Y
authors: Yoshimura
authors: O
authors: O
authors: Nishii
authors: Y
authors: Y
authors: Taketani
mesh_terms: D000328:Adult; D002996:Clomiphene / Q000627:therapeutic use; D004715:Endometriosis / Q000175:diagnosis; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy / Q000209:etiology*; D007889:Leiomyoma / Q000150:complications / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008596:Menotropins / Q000627:therapeutic use; D010062:Ovulation Induction; D010528:Peristalsis; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000503:physiopathology*; D018873:Pregnancy Rate; D011446:Prospective Studies; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000150:complications / Q000503:physiopathology*
chemical_list: D005300:Fertility Agents, Female; D002996:Clomiphene; D008596:Menotropins