Uterine Fibroids and Recurrent Pregnancy Loss

Fibroids are observed in up to 10.7% of pregnant women and may impact pregnancy outcome. The cumulative risk of sporadic miscarriage when intramural fibroids are noted in the first trimester via ultrasound was estimated to be 20.4%. However, the prevalence of uterine fibroids in women with recurrent pregnancy loss (RPL) is estimated to be only 4.08%. The workup for patients meeting the RPL diagnostic criteria should include genetic karyotype of both parents, endocrine evaluation, uterine assessment with evaluation of the endometrial cavity, and antiphospholipid antibody screening where appropriate. It is generally agreeable that submucous fibroids and intramural fibroids distorting the endometrial cavity should be removed particularly in the context of reproductive complications. On the other side, noncavity-distorting large endometrial fibroid may be associated with sporadic or recurrent pregnancy loss as illustrated in the two cases presented in this chapter. Properly designed studies to evaluate the impact of surgical removal of this subcategory on reproductive outcome are warranted.