title: Association of uterine fibroids and pregnancy outcomes after ovarian stimulation-intrauterine insemination for unexplained infertility.
abstract: OBJECTIVE
  To investigate the association of non-cavity-distorting uterine fibroids and pregnancy outcomes after ovarian stimulation-intrauterine insemination (OS-IUI) in couples with unexplained infertility.
  
  
  METHODS
  Secondary analysis from a prospective, randomized, multicenter clinical trial investigating fertility outcomes after OS-IUI.
  
  
  METHODS
  Reproductive Medicine Network clinical sites.
  
  
  METHODS
  Nine hundred couples with unexplained infertility who participated in the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) clinical trial.
  
  
  METHODS
  Participants were randomized to one of three arms (clomiphene citrate, letrozole, or gonadotropins), and treatment was continued for up to four cycles or until pregnancy was achieved.
  
  
  METHODS
  Conception (serum hCG increase), clinical pregnancy (fetal cardiac activity), and live birth rates.
  
  
  RESULTS
  A total of 102/900 participants (11.3%) had at least one documented fibroid and a normal uterine cavity. Women with fibroids were older, more likely to be African American, had a greater uterine volume, lower serum antimüllerian hormone levels, and fewer antral follicles than women without fibroids. In conception cycles, clinical pregnancy rates were significantly lower in participants with fibroids than in those without uterine fibroids. Pregnancy loss before 12 weeks was more likely in African American women with fibroids compared with non-African American women with fibroids. There was no difference in conception and live birth rates in subjects with and without fibroids.
  
  
  CONCLUSIONS
  No differences were observed in conception and live birth rates in women with non-cavity-distorting fibroids and those without fibroids. These findings provide reassurance that pregnancy success is not impacted in couples with non-cavity-distorting fibroids undergoing OS-IUI for unexplained infertility.
  
  
  BACKGROUND
  NCT01044862.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts. Electronic address: astyer@mgh.harvard.edu.
authors.forename: Aaron K
authors.initials: AK
authors.lastname: Styer
authors.affiliation: Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut.
authors.forename: Susan
authors.initials: S
authors.lastname: Jin
authors.affiliation: Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut.
authors.forename: Dan
authors.initials: D
authors.lastname: Liu
authors.affiliation: Shanghai, Jiao Tong University, Shanghai, People's Republic of China.
authors.forename: Baisong
authors.initials: B
authors.lastname: Wang
authors.affiliation: Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, Colorado.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Polotsky
authors.affiliation: Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Mindy S
authors.initials: MS
authors.lastname: Christianson
authors.affiliation: Department of Obstetrics and Gynecology, University of Rochester School of Medicine, Rochester, New York.
authors.forename: Wendy
authors.initials: W
authors.lastname: Vitek
authors.affiliation: Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Engmann
authors.affiliation: Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Karl
authors.initials: K
authors.lastname: Hansen
authors.affiliation: Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Robert
authors.initials: R
authors.lastname: Wild
authors.affiliation: Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, Pennsylvania.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Legro
authors.affiliation: Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Christos
authors.initials: C
authors.lastname: Coutifaris
authors.affiliation: Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Ruben
authors.initials: R
authors.lastname: Alvero
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Randal D
authors.initials: RD
authors.lastname: Robinson
authors.affiliation: Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont.
authors.forename: Peter
authors.initials: P
authors.lastname: Casson
authors.affiliation: Department of Obstetrics and Gynecology, Shands Hospital, University of Florida, Gainesville, Florida.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Christman
authors.affiliation: Division of Women's Reproductive Health, US Department of Veteran's Affairs, Washington, DC.
authors.forename: Alicia
authors.initials: A
authors.lastname: Christy
authors.affiliation: Department of Obstetrics and Gynecology, Augusta University, Augusta, Georgia.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Diamond
authors.affiliation: The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland.
authors.forename: Esther
authors.initials: E
authors.lastname: Eisenberg
authors.affiliation: Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut.
authors.forename: Heping
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, Colorado.
authors.forename: Nanette
authors.initials: N
authors.lastname: Santoro
mesh_terms: D000022:Abortion, Spontaneous / Q000208:ethnology; D000328:Adult; D001741:Black or African American; D004359:Drug Therapy, Combination; D005260:Female; D005298:Fertility / Q000187:drug effects; D005299:Fertility Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007246:Infertility / Q000150:complications / Q000208:ethnology / Q000503:physiopathology / Q000628:therapy*; D007315:Insemination, Artificial / Q000009:adverse effects; D007889:Leiomyoma / Q000150:complications* / Q000208:ethnology / Q000503:physiopathology; D050498:Live Birth; D010060:Ovulation / Q000187:drug effects*; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D011258:Pregnancy Tests; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014594:Uterine Neoplasms / Q000150:complications* / Q000208:ethnology / Q000503:physiopathology
chemical_list: D005299:Fertility Agents
keywords: Intrauterine insemination; ovarian stimulation; pregnancy; unexplained infertility; uterine fibroids