Laparoscopic myomectomy: fertility and pregnancy outcomes
Irena Kozachenko (RU), Leila Adamyan (RU), Veronika Smolnikova (RU), Irina Porotikova (RU)
[Kozachenko] Russian Scientific Center for Obstetrics and Gynecology , [Adamyan] Russian Scientific Center for Obstetrics and Gynecology , [Smolnikova] Russian Scientific Center for Obstetrics and Gynecology , [Porotikova] Russian Scientific Center for Obstetrics and Gynecology
Context There is a biological plausibility supporting a causal relationship between fibroids and infertility. This association is mostly supported by studies comparing pregnancy rate following IVF in women with and without fibroids. Objective To assess post-operative fertility rates and pregnancy outcomes of patients who had a Laparoscopic myomectomy (LM) from 2012 to 2014. Methods: laparoscopic myomectomy Patient(s): 437 patients with myoma (mean age of 40.55 +/-2.24 years). Intervention(s): We reviewed the medical records of 437 patients that underwent LM. Routine postoperative care involved obtaining follow up on their fertility and pregnancy outcomes. Main Outcome Measure(s): 354 of 437 patients (81%) provided fertility and pregnancy outcome data. Result(s): Follow-up from time of surgery to most recent charted data ranged from 10 months to 7.9 years. Of the 354 women, 212 (59.9%) actively tried for pregnancy after surgery. 73.2% of the 212 achieved a total of 155 pregnancies – 123 full term, 26 preterm, 16 spontaneous abortions and 2 termination. 90.4% of these patients underwent cesarean section. A subset of 104 women had pre-existing infertility. 25 of these patients underwent intrauterine insemination (IUI), while 79 underwent in vitro fertilization (IVF). After surgery, 60% of these patients achieved 62 total pregnancies. Of the 354 cases, there was one placenta accreta and no uterine ruptures. Conclusions The fertility rate after LM for all women attempting to conceive (73.2%) and for those with known infertility who continued to try for pregnancy (60%) was similar. There was a low incidence of major complications associated with the presence of uterine scarring in pregnancies conceived after laparoscopic myomectomy.