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Determinants of reproductive outcome after abdominal myomectomy for infertility
P Vercellini1, S Maddalena, O De Giorgi
1Clinica Ostetrica e Ginecologica Luigi Mangiagalli, University of Milano and Istituti Clinici di Perfezionamento, Italy. pgcros@imiucca.unimi.it
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.