Post-myomectomy age-specific ongoing pregnancy rates in women ≥37 years old: a retrospective non-comparative study

Data on reproductive outcomes after myomectomy in women of advanced reproductive age are limited. This study aimed to assess post-myomectomy age-specific ongoing pregnancy rates and associated impact factors for women aged 37 years and older.

This observational retrospective cohort study was conducted at a tertiary fibroid-expertise centre in Amsterdam, the Netherlands. Women aged 37 years or older with an active wish to conceive who underwent myomectomy between 2004 and 2022 were included. Data were retrieved from patient records and a questionnaire. The primary outcome was age-specific ongoing pregnancy rates. A multivariable logistic regression analysis was performed to identify predictive factors.

A total of 100 patients were included in the analysis. Follow up was a median of 24 months. The ongoing pregnancy rate was 36%, with an age-related trend showing rates of 46.4% in women under 40 years of age compared to 22.7% in women 40 years and older. The overall pregnancy rate was 44% resulting in 49 pregnancies of which 63.3% were live births, 28.6% miscarriages, 8.1% currently ongoing pregnancies and no intrauterine foetal deaths. The number of fibroids and age (<40 and ≥40 years) are both variables that significantly decrease the odds of achieving an ongoing pregnancy.

Ongoing pregnancy rates after myomectomy in this cohort of advanced age was relatively high, with an age-related decline in fertility. Women of advanced reproductive age can still achieve pregnancy after myomectomy, but these changes decrease after 40 as known from previous literature.