Abstract
The role of uterine fibroids (leiomyomata) in infertility has been the subject of debate for many years. Its importance as a topic of research has further increased as women delay childbirth into their 30s and 40s, when the incidence of fibroids is significantly increased. This article reviews the evidence for mechanisms by which fibroids may decrease fertility and the diagnostic and therapeutic options available to clinicians faced with a couple with fertility problems where fibroids are present. The majority of studies have looked at the location of fibroids within the uterus (submucosal, intramural and subserosal) to help determine their impact on fertility and spontaneous abortion rates. These studies have underlined the importance of location and distortion of the uterine cavity for fertility, although meta-analysis has highlighted a number of study design issues with suboptimal localization of fibroid position being a common problem in interpreting the exact role of intramural fibroids. Apart from physical location, other mechanisms have also been explored, including impaired uterine peristalsis, vascular changes and disruption of the uterine intracavity biochemical milieu.