Determinants of reproductive outcome after abdominal myomectomy for infertility

Abstract

Objective: To determine the effect of myomectomy as a therapy for infertility and to define the factors that influence reproductive outcome.

Design: Retrospective study of a case series.

Setting: An academic department specializing in conservative surgery.

Patient(s): A total of 138 infertile women who underwent first-line conservative surgical treatment at laparotomy for uterine leiomyomas over an 8-year period.

Intervention(s): Data were collected on baseline clinical characteristics, surgical details, and subsequent reproductive history.

Main outcome measure(s): Cumulative pregnancy rates at 24 months according to selected clinical and fibroid characteristics.

Result(s): Pregnancy occurred in 76 women. The 24-month cumulative probability of conception according to the Kaplan-Meier method was 87% in patients <30 years of age, 66% in patients 30-35 years of age, and 47% in patients >35 years of age. The pregnancy rates in women with and without minor infertility factors in addition to myomas were 56% and 71%, respectively, and those in women with <2 years versus > or =2 years of infertility were 84% and 51%, respectively. The size and site of the largest myoma and the total number of tumors removed did not influence the outcome.

Conclusion(s): Our results suggest a benefit of myomectomy in infertile patients. However, women should be counseled carefully before surgery because the determinants of outcome appear to be independent of treatment.