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Effects of myomas or prior myomectomy on in vitro fertilization (IVF) performance
M A Seoud1, R Patterson, S J Muasher
1Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, Department of Obstetrics and Gynecology, Norfolk 23507.
Objective:
The purpose of this study was to determine the effect of the presence of myomas and prior myomectomy on the pregnancy rate and pregnancy outcome in an in vitro fertilization (IVF) program.
Design:
Data collected from office and hospital records were analyzed retrospectively.
Setting:
Patients (all with private insurance carriers) were enrolled in an academic IVF program at The Jones Institute for Reproductive Medicine.
Patients:
All IVF patients enrolled in series 26-41, from 1987 to 1990, were reviewed. Only patients with well-documented myomas [by laparoscopy, laparotomy, hysteroscopy, or hysterosalpingography (HSG)] or prior myomectomy (confirmed by operative and pathology report) were included.
Main Outcome Measures:
Pregnancy rates and pregnancy outcome were the main outcome measures. Pregnancy rates were calculated per preovulatory embryo transfer. Chi-square, Student t-test, and the Whitney-Mann test were used in the statistical analysis and P less than 0.05 was considered significant.
Results:
Among 1415 IVF patients, 11 had confirmed myomas present and 47 others had prior myomectomies. The mean age of patients with myomas and myomectomy was 37.1 +/- 4.1 and 36.1 +/- 1.9 years, respectively. Ten of the patients with myoma had normal endometrial cavities on HSG. Subserosal tumors were present in 10 of 11 patients with myomas. Ten of the 47 myomectomy patients had an abnormal cavity prior to surgery and all were corrected. About half of the patients with prior myomectomy had subserous myomas, while 10% were submucous in location. Two of the patients had hysteroscopic removal; all the rest were performed abdominally. The ongoing pregnancy rate from fresh embryo transfer for patients with myomas and myomectomy was 20.8 and 16.9%, respectively. This was comparable to the 19.0% ongoing pregnancy rate for all patients in these series. Despite the small number, and the fact that most had subserosal myomas, patients with myomas had a 50% abortion rate, while those postmyomectomy had a 34.2% abortion rate (statistically not significant). Moreover, if subdivided by their primary IVF indications, patients with prior myomectomy had similar ongoing pregnancy rates from fresh embryo transfer compared to the whole IVF population.
Conclusion:
The incidence of myomas or prior myomectomy among infertility patients presenting for IVF was rather low. Myomectomy did not interfere with IVF performance in relation to overall and ongoing pregnancy rate.