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What causes tumor of the uterus?

Leiomyomata are the most common tumors of the uterus, occurring most commonly in women of reproductive age, particularly in the 30s and 40s. The impact of fibroids on fertility depends on the parameters of location, number, and size.

Types of leiomyomata include

1. subserosal

2. intramural

3. submucosal varieties.

Submucous myomas, by virtue of their mass effect and inhospitable surface area, have been clearly associated with infertility and with pregnancy loss.

These myomas appear as rounded masses that bulge to varying extents into the endometrial cavity, and the overlying endometrium may be atrophic, congested, ulcerated, or hemorrhagic. Because of their intracavitary location, submucosal fibroids may be effectively removed via a hysteroscopic approach.
Sonohysterography and hysteroscopy are equivalent in the detection of sub-mucosal myomas. Whereas SIS offers the advantage of allowing measurement of the overall dimensions of the lesion, office hysteroscopy may afford the removal of small submucous lesions in the same setting.

The impact of intramural (defined as greater than 50% volume within the myometrium) myomas upon fertility remains controversial. Although some studies showed reduced implantation and conception rates in women with intramural fibroids, others have not demonstrated an adverse effect.

One study demonstrated a size dependent impact of intramural myomas, with those measuring greater than 4 cm associated with lower pregnancy rates following IVF/ICSI treatment. The mechanism by which intramural lesions may impair fertility is unproven.

Alterations in uterine artery blood flow, local cytokine release, and/or gene expression profiles have been purported.
Insofar as leiomyomata cluster with other estrogen-dependent disorders, such as endometriosis, adenomyosis, and endometrial polyps, their role in infertility may be purely associative.
Nonetheless, an in-depth review of six previously published trials concluded that only intramural fibroids that resulted in cavity distortion or impingement were deleterious to fertility.

The beneficial effect of removing such cavity-distorting lesions was validated in a recent case controlled study.
Finally, studies have consistently failed to find an impact of
subserosal leiomyomata (defined as ≥50% volume projecting
beyond the outer uterine contour) upon fertility.

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