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Laparoscopic myomectomy and pregnancy outcome in infertile patients
S C Ribeiro1, H Reich, J Rosenberg
1College of Physicians and Surgeons of Columbia University, New York, New York, USA.
Objective:
To assess outcomes and pregnancy-related complications after laparoscopic myomectomy in infertile patients.
Design:
Retrospective analysis.
Setting:
Tertiary care advanced laparoscopic center.
Patient(S):
Twenty-eight infertile patients with at least one uterine leiomyoma of >5 cm in diameter.
Intervention(S):
Laparoscopic myomectomy.
Main Outcome Measure(S):
Occurrence of pregnancy, delivery rate, and pregnancy-related complications.
Result(S):
The average size of the myomas removed was 6 cm (range, 4-13.3 cm). None of the procedures were converted to laparotomy. The postoperative rate of intrauterine pregnancy was 64.3% (n = 18), including 1 of 2 patients who underwent concomitant hysteroscopic myomectomy. Four patients had spontaneous abortions and 14 delivered viable term neonates. Six women had a vaginal delivery without complications and 8 had a cesarean section. No antepartum or intrapartum complications were reported.
Conclusion(S):
Laparoscopic myomectomy can be offered to patients who want to have children and who refuse to undergo an abdominal myomectomy. Patient selection as well as meticulous surgical technique are the key factors in achieving a successful outcome.