Fibroids and Fertility

Integrated pharmacoanalysis, bioinformatics analysis, and experimental validation to identify the ingredients and mechanisms of Xiao-Luo-Wan in uterine fibroids treatment

CONTEXT

Xiao-Luo-Wan (XLW), a classical prescription in traditional Chinese medicine, has therapeutic effects on uterine fibroids (UFs). Herein, its anti-UF effects were examined using a systematic pharmacological method.

OBJECTIVE

To explore the active ingredients of XLW via mass spectrometry and its potential effects on UFs by network pharmacology, molecular docking, and experimental validation.

MATERIALS AND METHODS

A mass spectrometer was used to scrutinize the composition of the XLW drug-containing serum. The critical targets and potential mechanisms of XLW against UFs were predicted by network pharmacology and molecular docking. Next, human uterine leiomyoma cells (UMCs) were treated with 20%, 30%, or 40% XLW serum for 24 h, 48 h or 72 h. Cell viability was analyzed via a CCK-8 assay, and cell apoptosis and the cell cycle were examined via flow cytometry. The predicted targets were further identified by RT-PCR and western blotting.

RESULTS

There were 16 chemical components identified in XLW drug-containing serum, with 53 target genes predicated in the treatment of UFs. The molecular binding of core targets, including TRIM9, NF-κB and p38MAPK, was relatively stable to components, especially buergerinin B, cedrol and ent-15B-16-epoxy- kauan-17-ol. The in vitro experiments revealed that the IC50 of XLW in UMCs was 63.21%, and the anti-UF effects of XLW may be closely associated with targets that inhibit cell proliferation and promote cell apoptosis by regulating TRIM9, NF-κB and p38MAPK expression.

DISCUSSION AND CONCLUSIONS

The integration of mass spectrometry, network pharmacology, molecular docking and biological experiments revealed the key constituents of XLW and its pharmacological mechanism in UFs, which may help in the discovery of therapeutic agents for treating UFs.

Impact of fibroids on fertility, pregnancy loss, and preconception management

PURPOSE OF REVIEW

Although fibroids are understood to be a predominantly benign and common pathology, they can have significant impacts on patients' quality of life and reproductive health. This review summarizes the impact of uterine fibroids on fertility and spontaneous abortion, while also addressing how the treatment for fibroids can affect fertility. Lastly, the review will address strategies for preconception management of fibroids to optimize patients' reproductive health.

RECENT FINDINGS

The data regarding the impact of fibroids on fertility and pregnancy loss is evolving. However, it is agreed that the impact of fibroids is predominantly determined by their location in the uterus. Fibroids located in the submucosal layer or otherwise disrupting the endometrial cavity can impede the implantation of an embryo or potentially increase the risk of spontaneous abortion. When treating fibroids for the purpose of fertility, surgical management is preferred over medication management. There is limited data supporting procedures such as uterine artery embolization or radiofrequency ablation for the management of fibroids to improve fertility. Surgical management of fibroids not impacting the uterine cavity remains controversial.

SUMMARY

Uterine fibroids can have a detrimental impact on fertility and therefore require purposeful attention to both the diagnosis and management of the condition in reproductive-aged women. The treatment of fibroids for the purpose of fertility alone remains controversial. Regardless, fibroid size and location should be cataloged, and surgical management should be offered to patients experiencing difficulties with conception.

Uterine Leiomyomas and Infertility: A Comparison of National and International Guidelines

Uterine leiomyomas are the most common benign tumors of the female genital track, causing various symptoms and problems, including a possible impact on fertility. The relationship between fibroids and infertility has long been a debate among gynecologists. Management of fibroids in women with otherwise unexplained infertility worldwide lacks standardized, evidence-based guidelines. Therefore, a review of guidelines from the Royal Australian and New Zealand College of Obstetricians and Gynecologists, the American College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, the Collège National des Gynécologues et Obstétriciens Français, and the American Society of Reproductive Medicine was conducted. There is agreement among all guidelines that the effect of fibroids on fertility is related to their position in the uterus and the alteration of the endometrial cavity. However, whether surgical intervention (laparotomy, laparoscopy, or hysteroscopy) is required varies among committees. More specifically, for submucous myomas, all guidelines agree that surgical intervention is needed. On the other hand, regarding intramural myomas, there is no consensus on what the approach may be. Novel treatments such as uterine artery embolization (UAE) and magnetic resonance-guided focused ultrasound surgery (MRgFUS) should only be used in clinical trial settings. Nevertheless, all guidelines agree that medical management of fibroids further delays efforts to conceive and has no role as a stand-alone treatment of fibroids; though, the use of GnRH analogues preoperatively can be useful to improve anemia and/or reduce fibroid volume. There is a need for updated international protocols to be introduced, in order to help clinicians dealing with fibroids and infertility to better suggest the optimal treatment.