Fibroids, infertility and laparoscopic myomectomy

Area of Science:

• Reproductive Medicine
• Minimally Invasive Surgery
• Gynecologic Oncology

Background:

• Uterine fibroids (leiomyomata) are common benign tumors that can impact female fertility.
• The relationship between fibroid type and location and infertility is complex.
• Surgical intervention, particularly myomectomy, is often considered for fibroids affecting fertility.

Purpose of the Study:

• To synthesize current evidence on the association between uterine fibroids and infertility.
• To evaluate the efficacy and safety of laparoscopic myomectomy for improving fertility outcomes.

Main Methods:

• Comprehensive literature search of Medline, PubMed, and Cochrane Databases.
• Inclusion of studies published between 1980 and 2010.
• Review and synthesis of data on fibroid type, surgical approach, and fertility outcomes.

Main Results:

• Submucosal fibroids significantly decrease fertility; myomectomy is beneficial.
• Subserosal fibroids do not appear to impact fertility; removal offers no clear advantage.
• Intramural fibroids may reduce fertility, but treatment outcomes are uncertain.
• Laparoscopic myomectomy shows comparable pregnancy rates to laparotomy but carries unknown risks of uterine rupture and potentially higher recurrence rates.

Conclusions:

• Laparoscopic myomectomy, performed by experienced surgeons, is a safe procedure with a low failure rate.
• This approach yields good pregnancy outcomes for women with fibroids.
• Further research is needed to clarify risks associated with laparoscopic myomectomy, especially uterine rupture and recurrence.