Management děložních myomů u ženve fertilním věku

Management of Uterine Myomas in Womenof Fertile Age

Objective:
Review of current knowledge about uterine fibroids management in young women.Analysis of possible diagnostic and therapeutic algorithms regarding fertility preserving.Design: Review article.Setting: Department of Obstetrics and Gynecology, 1st Faculty of Medicine and the General FacultyHospital, Charles University, Prague.Methods: Analysis of the facts in literature (texts in medical journals, monographies, textbooks,internet database Medline and Ovid) and authors’ clinical experience.Conclusions: Alternatives of treatment of infertility in women with uterine fibroids have significantlyenlarged in past 10 years. However none of the indicated methods is perfect. Expectationdoes not exclude the risk of growth of fibroids and abortion. The effect of pharmacologicaltherapy is only temporary. Myomectomy is associated with the risk of surgical complications,fibroids’ recurrence and uterine rupture in subsequent gestation. Although uterine artery embolisation(on an average) halves the fibroids volume, the long-term effect of the method on femalefertility is still unknown. Nevertheless it seems convenient to advise the active approach to allwomen planning pregnancy and having significant (submucous or intramural) fibroid even beforespontaneous or assisted conception. Most recent studies indicate significant improvement of reproductionoutcomes after myomectomy, especially in young women with the absence of otherfactors of infertility. Only the results of randomized, controlled trials (that are still awaited) willinform us about comparison of the effects and risks of myomectomy and uterine artery embolizationin management of infertility.

Key words:
fertility preserving, myomectomy, uterine fibroid, uterine artery embolisation