Route of myomectomy and fertility: a prospective cohort study

doi:10.1016/j.fertnstert.2022.01.013

. 2022 May;117(5):1083-1093.

doi: 10.1016/j.fertnstert.2022.01.013. Epub 2022 Feb 23.

Route of myomectomy and fertility: a prospective cohort study

Lauren A Wise¹, Laine Thomas², Sophia Anderson², Donna D Baird³, Raymond M Anchan⁴, Kathryn L Terry⁴, Erica E Marsh⁵, Ganesa Wegienka⁶, Wanda Kay Nicholson⁷, Kedra Wallace⁸, Robert Bigelow⁹, James Spies¹⁰, George L Maxwell¹¹, Vanessa Jacoby¹², Evan R Myers¹³, Elizabeth A Stewart¹⁴

Affiliations

¹ Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts. Electronic address: lwise@bu.edu.
² Department of Biostatistics, Duke University, Durham, North Carolina.
³ Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, North Carolina.
⁴ Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts.
⁵ Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan.
⁶ Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan.
⁷ Center for Women's Health Research, Department of Obstetrics and Gynecology, UNC School of Medicine, Chapel Hill, North Carolina.
⁸ Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi.
⁹ Duke Clinical Research Institute, Duke University, Durham, North Carolina.
¹⁰ Department of Radiology, MedStar Georgetown University Hospital, Washington, D.C.
¹¹ Department of Obstetrics and Gynecology and the Women's Health Integrated Research Center, Inova Fairfax Hospital, Falls Church, Virginia.
¹² School of Medicine, University of California San Francisco, San Francisco California.
¹³ Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina.
¹⁴ Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.

PMID: 35216832
PMCID: PMC9081130
DOI: 10.1016/j.fertnstert.2022.01.013

Route of myomectomy and fertility: a prospective cohort study

Lauren A Wise et al. Fertil Steril. 2022 May.

. 2022 May;117(5):1083-1093.

doi: 10.1016/j.fertnstert.2022.01.013. Epub 2022 Feb 23.

Authors

Affiliations

¹ Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts. Electronic address: lwise@bu.edu.
² Department of Biostatistics, Duke University, Durham, North Carolina.
³ Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, North Carolina.
⁴ Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts.
⁵ Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan.
⁶ Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan.
⁷ Center for Women's Health Research, Department of Obstetrics and Gynecology, UNC School of Medicine, Chapel Hill, North Carolina.
⁸ Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi.
⁹ Duke Clinical Research Institute, Duke University, Durham, North Carolina.
¹⁰ Department of Radiology, MedStar Georgetown University Hospital, Washington, D.C.
¹¹ Department of Obstetrics and Gynecology and the Women's Health Integrated Research Center, Inova Fairfax Hospital, Falls Church, Virginia.
¹² School of Medicine, University of California San Francisco, San Francisco California.
¹³ Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina.
¹⁴ Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.

PMID: 35216832
PMCID: PMC9081130
DOI: 10.1016/j.fertnstert.2022.01.013

Abstract

Objective: To assess prospectively the association between the myomectomy route and fertility.

Design: Prospective cohort study.

Setting: The Comparing Treatments Options for Uterine Fibroids (COMPARE-UF) Study is a multisite national registry of eight clinic centers across the United States.

Patient(s): Reproductive-aged women undergoing surgery for symptomatic uterine fibroids.

Intervention(s): Not applicable.

Main outcome measure(s): We used life-table methods to estimate cumulative probabilities and 95% confidence intervals (CI) of pregnancy and live birth by the myomectomy route during 12, 24, and 36 months of follow-up (2015-2019). We also conducted 12-month interval-based analyses that used logistic regression to estimate odds ratios and 95% CIs for associations of interest. In all analyses, we used propensity score weighting to adjust for differences across surgical routes.

Result(s): Among 1,095 women who underwent myomectomy (abdominal = 388, hysteroscopic = 273, and laparoscopic = 434), 202 reported pregnancy and 91 reported live birth during 36 months of follow-up. There was little difference in the 12-month probability of pregnancy or live birth by route of myomectomy overall or among women intending pregnancy. In interval-based analyses, adjusted ORs for pregnancy were 1.28 (95% CI, 0.76-2.14) for hysteroscopic myomectomy and 1.19 (95% CI, 0.76-1.85) for laparoscopic myomectomy compared with abdominal myomectomy. Among women intending pregnancy, adjusted ORs were 1.27 (95% CI, 0.72-2.23) for hysteroscopic myomectomy and 1.26 (95% CI, 0.77-2.04) for laparoscopic myomectomy compared with abdominal myomectomy. Associations were slightly stronger but less precise for live birth.

Conclusion(s): The probability of conception or live birth did not differ appreciably by the myomectomy route among women observed for 36 months postoperatively.

Clinical trials registration number: (NCT02260752, clinicaltrials.gov).

Keywords: Fibroids; fertility; myomectomy; pregnancy.

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Comment in

Uterine leiomyomas: actionable evidence needed!
Munro MG. Munro MG. Fertil Steril. 2022 May;117(5):1094-1095. doi: 10.1016/j.fertnstert.2022.02.029. Fertil Steril. 2022. PMID: 35512970 No abstract available.

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References

1. Wilcox LS, Koonin LM, Pokras R, Strauss LT, Xia Z, Peterson HB. Hysterectomy in the United States, 1988–1990. Obstet Gynecol 1994;83:549–55. - PubMed
1. Farquhar CM, Steiner CA. Hysterectomy rates in the United States 1990–1997. Obstet Gynecol 2002;99(2):229–34. - PubMed
1. Flynn M, Jamison M, Datta S, Myers E. Health care resource use for uterine fibroid tumors in the United States. Am J Obstet Gynecol 2006;195(4):955–64. - PubMed
1. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003;188(1):100–7. - PubMed
1. Marshall LM, Spiegelman D, Barbieri RL, Goldman MB, Manson JE, Colditz GA, et al. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol 1997;90(6):967–73. - PubMed

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[1] Wilcox LS, Koonin LM, Pokras R, Strauss LT, Xia Z, Peterson HB. Hysterectomy in the United States, 1988–1990. Obstet Gynecol 1994;83:549–55. - PubMed

[2] Wilcox LS, Koonin LM, Pokras R, Strauss LT, Xia Z, Peterson HB. Hysterectomy in the United States, 1988–1990. Obstet Gynecol 1994;83:549–55. - PubMed

[3] Farquhar CM, Steiner CA. Hysterectomy rates in the United States 1990–1997. Obstet Gynecol 2002;99(2):229–34. - PubMed

[4] Farquhar CM, Steiner CA. Hysterectomy rates in the United States 1990–1997. Obstet Gynecol 2002;99(2):229–34. - PubMed

[5] Flynn M, Jamison M, Datta S, Myers E. Health care resource use for uterine fibroid tumors in the United States. Am J Obstet Gynecol 2006;195(4):955–64. - PubMed

[6] Flynn M, Jamison M, Datta S, Myers E. Health care resource use for uterine fibroid tumors in the United States. Am J Obstet Gynecol 2006;195(4):955–64. - PubMed

[7] Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003;188(1):100–7. - PubMed

[8] Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003;188(1):100–7. - PubMed

[9] Marshall LM, Spiegelman D, Barbieri RL, Goldman MB, Manson JE, Colditz GA, et al. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol 1997;90(6):967–73. - PubMed

[10] Marshall LM, Spiegelman D, Barbieri RL, Goldman MB, Manson JE, Colditz GA, et al. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol 1997;90(6):967–73. - PubMed

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Route of myomectomy and fertility: a prospective cohort study

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Route of myomectomy and fertility: a prospective cohort study

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