Determinants of reproductive outcome after abdominal myomectomy for infertility

Vercellini, Paolo; Maddalena, S; Giorgi, Olga De; Pesole, Antonella; Ferrari, Luisa; Crosignani, Pier Giorgio

doi:10.1016/s0015-0282(99)00200-9

Cited by 100 publications

(54 citation statements)

References 19 publications

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“…In retrospective studies a reduction of loss is found after myomectomy, from 73% to 13% [23] and 60% to 24% [24], respectively, but there are no prospective or randomised trials to support these results. Submucous myomas tend to be more likely to cause recurrent miscarriage, but evidence for this relationship is even more limited [22].…”

Section: Subfertilitymentioning

confidence: 97%

Submucous myomas: diagnosis and therapy

et al. 2007

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In this review problems concerning diagnosis and therapy of submucous myomas are discussed. In abnormal blood loss, especially during menstrual periods, it is probable that the submucous locations of fibroids have the strongest relationship with the symptoms. Both in diagnostic and therapeutic possibilities, in the past decennium, a wide range of fine tuning has been developed that has changed dramatically the optimal management of submucous myomas and, therefore, of bleeding abnormalities during premenopause. Over-treatment can thus be prevented: for instance, hysterectomy in menorrhagia caused by a small pedunculated submucous fibroid. New modalities of minimally invasive treatment, however, have specific intrinsic problems that justify the development of protocols for these techniques. For the diagnosis of submucous myoma, and preceding operative treatment, intrauterine diagnosis through ultrasound or hysteroscopic imaging is mandatory. Hysteroscopic treatment of submucous myomas is the method of preference, unless the abnormality is too large or too numerous. Various practical aspects of treatment are discussed. Surgery for abnormalities that are not included in the basic training package according to Goals for the education of gynaecologists, ought to be performed by a gynaecologist with additional training and experience.

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Section: Subfertilitymentioning

confidence: 97%

Submucous myomas: diagnosis and therapy

et al. 2007

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“…To determine the effects of hysteroscopic myomectomy on menorrhagia and infertility, the long-term outcomes of 108 women who underwent hysteroscopic resection of submucosal (n=54), sessile (n=30), or intramural (n=24) leiomyomas over 7 years were investigated [47,48]. After a mean follow-up of 41 months, myomas recurred in 27 subjects, with a 3-year cumulative rate of 34%.…”

Section: Infertilitymentioning

confidence: 99%

Conservative treatment of fibroids

Istre

2007

Gynecol Surg

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“…O tamanho tumoral não influenciou significativamente os resul-tados terapêuticos, 11 conclusão também sugerida por outros autores. 9,10 Na série de Donnez e Jadoul 5 houve diminuição significativa nas taxas de gestação após FIV em pacientes com deformação da cavidade uterina (conseqüência, sobretudo de miomas submucosos), quando comparadas a mulheres sem alteração da cavidade ou com infertilidade não associada a miomas. Ng e Ho, 3 assim como Pritts 11 obtiveram resultados semelhantes.…”

Section: Fisiopatologiaunclassified

“…10 Através da análise dos principais estudos avaliando a relação entre miomas e infertilidade, parece não haver correlação entre as taxas de gestação após tratamento por miomectomia e o número e tamanho dos miomas ressecados. 4 Além disso, observa-se que cerca de 75% das pacientes submetidas a esse procedimento conseguem engravidar no período de um ano.…”

Section: Tratamento Hormonalunclassified

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Miomas e infertilidade: bases fisiopatológicas e implicações terapêuticas

Silva

Seibel

Capp

et al. 2005

Rev. Bras. Saude Mater. Infant.

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Objectives: to analyze evidences in medical literature concerning the possible relation between uterine leiomyomas and infertility, and the advantages /disadvantages of the different treatments available.Methods: literature review using the key words (MeSh terms) "leiomyomas", "infertility", "treatment", "myomectomy", "pregnancy" in "Pubmed" and "The Cochrane Library 2003" database. The search period was from 1989 through 2003.Results: although there are contradictory results, the majority of authors determined a possible cause-consequence relation between some types of leiomyomas and reproductive impairement. Concerning therapeutics, we were able to clearly place myomectomy as being the surgical technique with the best results. Surgical approaches used for this procedure did not show significant differences from each other, except for submucosal myomas, where histeroscopy is more effective. Other existent treatment options do not seem to be indicated for infertile patients with uterine leiomyomas.Conclusions: the possible association between myomas and reproductive impairment needs to be further investigated. Success indicated by gestational rates following surgical resection, mainly in patients with submucosal myomas, are an indication that they do have a role in infertility etiology. Concerning the treatment, it became clear that myomectomy is the procedure of choice for all patients desiring to become pregnant. Key words Myomas, Infertility, female, Pregnancy ResumoObjetivos: analisar evidências da literatura médi-ca que avaliam a relação entre miomas uterinos e infertilidade, assim como as vantagens e desvantagens dos diferentes tipos de tratamentos disponíveis.Métodos: foi realizada uma revisão da literatura utilizando os termos (MeSh terms) "miomas", "infertilidade", "tratamento", "miomectomia", "gestação", na base de dados "Pubmed" e na "The Cochrane Library 2003". O período analisado foi de 1989 a 2003.Resultados: apesar de alguns resultados contraditórios, a maioria dos autores relata uma possível relação de causa-conseqüência entre determinados tipos de miomas e distúrbios reprodutivos. Em relação à terapêutica, observa-se claramente que a miomectomia representa a técnica cirúrgica com melhores resultados, não havendo diferença significativa entre as vias de acesso utilizadas, com exceção da miomatose submucosa, situação em que a via histeroscópica é preferida. As opções não-cirúrgicas de tratamento existentes não parecem ter indicação em pacientes inférteis.Conclusões: a possível associação entre miomas e distúrbios reprodutivos necessita de melhores investigações. O incremento nas taxas de gestação após ressecção cirúrgica de miomas submucosos leva-nos a acreditar que esses tumores tenham papel na etiologia da infertilidade. Em miomas de outras localizações, entretanto, a relação com infertilidade não é tão clara. A miomectomia é o procedimento de escolha para as pacientes que ainda desejam engravidar.Palavras-chave Mioma, Infertilidade feminina, Gravidez

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Determinants of reproductive outcome after abdominal myomectomy for infertility

Cited by 100 publications

References 19 publications

Submucous myomas: diagnosis and therapy

Submucous myomas: diagnosis and therapy

Conservative treatment of fibroids

Miomas e infertilidade: bases fisiopatológicas e implicações terapêuticas

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