Reproductive outcome after laparoscopic myomectomy in infertile women

To assess reproductive outcome after laparoscopic myomectomies for interstitial and/or subserosal myomas in infertile women with or without associated infertility factors.

In this observational study, 91 women with infertility for one year and at least one interstitial and/or subserosal myoma > 20 mm were treated with laparoscopic myomectomy. All patients were mailed questions about fertility and pregnancy outcome. Cumulative pregnancy rates were calculated by the Kaplan-Meier method. The log rank test and Cox's model were used for comparing the spontaneous pregnancy rate in patients with and without associated infertility factors.

The mean age of the patients was 35 +/- 4 years. The mean duration of infertility was 44 +/- 33 months. Twenty-five patients (27.5%) had no associated infertility factors, and 66 (72.5%) had one or more. The mean size of the largest myomas was 45 +/- 19 mm. The mean number of myomas removed was 2.0 +/- 1.4. Eighty-six patients had laparoscopic myomectomy (94.5%), and five had laparoscopically assisted myomectomy (5.5%). There were no conversions to laparotomy. Ten patients were lost to follow-up (11.0%). Among the 91 patients treated surgically, 81 (89.0%) of them were evaluated. Forty-three (53.1%) conceived, resulting in a total of 51 pregnancies. The two-year overall cumulative conception rate was 51.2% (95% confidence interval [CI], 39.2-63.2%). The two-year spontaneous pregnancy rate was 43.9% (95% CI, 32.1-55.7%). This rate was 69.9% (95% CI, 50.3-89.5%) for patients with no associated factors and 31.5% (95% CI, 18.4-44.6%) for patients with associated factors (P < .001). This result was not affected by adjusting for age or duration of infertility.

Laparoscopic myomectomy seems to be a good procedure for patients with myomas and no other infertility factors. In cases with associated infertility factors, the need for myomectomy has to be studied.