Background: Uterine fibroids (UF) including those with non-cavity distorting variant can cause infertility. When these women require IVF treatment, controversies whether its presence will negatively impact on their IVF outcomes has been debated. The heterogenous nature of UF has given inconsistent results in many published studies. Besides that, available meta-analysis on this subject is dated and has significant heterogeneity. Moreover, IVF techniques and protocols have also rapidly evolved since the last review. An updated review and Meta-Analysis is needed to give informed choice to patient and IVF practitioner.

Objective: To review and meta-analyse available data from controlled studies.

Methods: We performed a systematic review and meta-analysis on extracted data according to PRISMA. Relevant articles were selected from literature search that was carried out using Medline, Embase, and Web of science. Both randomised and non-randomised controlled studies were included. Our primary outcome is live birth rate (LBR) and secondary outcomes are clinical pregnancy rate (CPR), implantation rate (IR) and miscarriage rate (MR). Qualities of included studies were scored using Newcastle-Ottawa Quality Assessment Scales and meta-analysis conducted by using RevMan 5.3.

Results: We found 2,482 articles but included only 26 articles, which were non-randomised studies, based on inclusion and exclusion criteria, with total of 8,340 IVF cycles. Fourteen (n=14/26) studies included intramural fibroids (IM) with subserosal fibroids (SS) and only 12 (n=12/26) reported IM alone. We found that, compared to women with no fibroid, non-cavity distorting IM with or without SS has lower CPR (RR= 0.83, 95% CI=0.77-0.89, P< 0.000, I²=42%, 7,685 cycles, 24 studies), LBR (RR=0.80, 95% CI=0.73-0.87, P< 0.000, I²=40%, 5,453 cycles, 16 studies) and higher MR (RR=1.26, 95% CI=1.06-1.50, P=0.009, I²=21%, 2,623 cycles, 15 studies). Whereas, IR (RR=0.9, 95% CI=0.81-1.01, P= 0.07, I²=33%, 6,845 cycles, 10 studies) is similar. Subgroup analysis exclusive on non-cavity distorting IM, showed lower CPR (RR=0.84, 95% CI=0.77-0.92, P< 0.000, I²=18%, 4,336 cycles, 12 studies), LBR (RR=0.83, 95% CI=0.73-0.94, P=0.005, I²=32%, 2,171 cycles, 6 studies) and higher MR (RR=1.42, 95% CI=1.04-1.94, P=0.03, I²=0%, 1,524 cycles, 9 studies) However, IR (RR=0.71, 95% CI=0.49-1.02, P= 0.07, I²=81%, 1,511 cycles, 5 studies) is similar.

Conclusion: Presence of non-cavity distorting IM with or without SS will reduce LBR, CPR, and increase MR without affecting IR. Although, this is the largest and most updated systematic review and meta-analysis, the result still has significant heterogeneity and needs careful interpretation.