Non-hysteroscopic Myomectomy and Fertility Outcomes: A Systematic Review

Area of Science:

• Reproductive Medicine
• Minimally Invasive Surgery
• Gynecologic Oncology

Background:

• Uterine fibroids (myomas) are common and can impact fertility.
• Nonhysteroscopic myomectomy is a surgical option for women desiring future fertility.
• Optimizing surgical techniques and patient selection is crucial for reproductive outcomes.

Purpose of the Study:

• To systematically review literature on best practices for nonhysteroscopic myomectomy in women with myomas seeking future fertility.
• To identify factors influencing conception and pregnancy outcomes post-myomectomy.
• To evaluate the impact of surgical route and techniques on reproductive success.

Main Methods:

• Systematic literature search of Ovid MEDLINE, Embase, and Cochrane CENTRAL databases.
• Inclusion of studies on women undergoing laparotomy or laparoscopy for myomectomy.
• Quality assessment using NIH tools and evidence-based grading for recommendations.

Main Results:

• Younger age, fewer myomas, and less endometrial cavity distortion correlate with better reproductive outcomes.
• Surgical route (laparotomy vs. laparoscopy) and uterine artery occlusion did not significantly impact pregnancy rates.
• Adhesion barriers warrant further investigation as a potential research area.

Conclusions:

• Insights provided for patient selection and intraoperative techniques in nonhysteroscopic myomectomy.
• Further research with clinical trials is needed to clarify the relationship between myoma characteristics and reproductive outcomes.