Impact of FIGO type 3 uterine fibroids on in vitro fertilization outcomes: A systematic review and meta‐analysis

Background The effect of FIGO (the International Federation of Gynecology & Obstetrics) type 3 myomas on in vitro fertilization (IVF) is uncertain. Objectives To evaluate whether FIGO type 3 myomas affect IVF outcomes, through a systematic review and meta-analysis (CRD42022379700). Search strategy Electronic databases were searched until November 15, 2022. Selection criteria Studies evaluating the effects of FIGO type 3 myomas on IVF outcome. Data collection and analysis Pooled results were expressed as odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was assessed using Higgins I-2. Sources of heterogeneity were explored with sensitivity and subgroup analyses. Main results In total, 1020 patients were included: 324 with FIGO type 3 myomas and 696 controls (without myomas). A pooled data analysis showed a significantly lower live birth rate (OR 2.16, 95% CI 1.55-3.01, I-2 = 0%, P < 0.00001), clinical pregnancy rate (OR 2.06, 95% CI 1.52-2.81, I-2 = 0%, P < 0.00001), and implantation rate (OR 1.77, 95% CI 1.35-2.32, I-2 = 0%, P < 0.00001) in women with untreated myomas compared with controls. The number and size of fibroids correlated with a worsening of IVF outcomes. Conclusions FIGO type 3 myomas are significantly associated with a lower implantation rate, cumulative pregnancy rate, and live birth rate. Furthermore, their deleterious effect on the outcome of IVF increases further with increasing size and number. Nevertheless, no firm conclusions could be drawn about the potential benefits of surgery for FIGO type 3 uterine fibroids on IVF outcomes.