Improved Fertility Following Enucleation of Intramural Myomas in Infertile Women

Abstract

Background:The relationship between intramural myomas and fertility remains unclear. The main debate rests on whether cavity-distorting intramural myomas (CDMs) adversely affect fertility more than non-CDMs. We aimed to compare the effects of enucleating non-CDMs and CDMs on fertility improvement in females with unexplained infertility.Methods:We prospectively recruited 83 women undergoing myomectomy for unexplained infertility with intramural myomas between June 2008 and November 2012 and classified them into non-CDMs group (n = 45) and CDMs group (n = 38). We then compared postoperative infertility rates, spontaneous pregnancy rates, pregnancy outcomes, live birth rates, and obstetric complications. For continuous variables, we calculated the mean ± standard deviation, median and interquartile range, and analyzed the data using Student's t-test and the Mann-Whitney U-test. For categorical variables, the Pearson's Chi-square test, the continuity correction test, and Fisher's exact test were used.Results:Patients’ demographics and myoma characteristics were comparable between the two groups. The overall spontaneous pregnancy rate increased from 0% to 68.42% following myomectomy. The postoperative infertility rate was significantly higher in the non-CDMs group than that in the CDMs group (50.00% vs. 23.53%, t = 5.579, P = 0.018), whereas the postoperative spontaneous pregnancy rate was significantly lower in the non-CDMs group than that in the CDMs group (47.62% vs. 70.59%, t = 4.067, P = 0.044). Compared with the enucleation of non-CDM, the enucleation of CDM patients was a protective factor for the fertility restoration (risk ratio [RR] = 3.717, 95% confidence interval [CI]: 1.284–10.753, P = 0.015), although postoperative fertility restoration declined with age (RR = 1.141, 95% CI: 1.005–1.295, P = 0.041).Conclusions:Intramural myomas are associated with impaired fertility. Women experiencing unexplained infertility, and possessing intramural myomas, have a better chance of conception following myomectomy, and these benefits are more obvious for younger patients and patients with CDM.

Time to conceive after myomectomy: should we advise a minimum time interval? A systematic review

“…Likewise, this review did not consider the position of fibroids due to the lack of data available. This is a factor which may have an impact on fertility, depending on whether the myoma is intramural or subserous, or if it is distorting the uterine cavity (Tian et al, 2017).…”

Non-hysteroscopic Myomectomy and Fertility Outcomes: A Systematic Review

“…Ten studies identified for this review focused on the impacts of the route of abdominal myomectomy on fertility (Table 5). Two other papers [9,20] performed secondary analyses related to surgical modality, and their findings are included in this topic section. We specifically examined the surgical techniques of laparotomic (also referred to in this review as open) and laparoscopic myomectomy.…”

“…Five articles incorporating data from 829 patients studied fertility after laparotomic vs laparoscopic myomectomy [9,20 −23], with inconsistent results regarding pregnancy rates by surgical route. One RCT (n = 131) found no difference in pregnancy rates on the basis of the route of surgery (laparotomic 56% vs laparoscopic 54%) [21], whereas 2 cohort studies showed a trend toward increased pregnancy rates among patients who received a laparoscopic approach [9,23], and another noted higher postoperative pregnancy rates among patients who underwent laparotomic myomectomy [20].…”

“…Among the included studies, the route of surgery was not associated with the method of delivery (vaginal vs cesarean) for all patients who conceived [20,21,23] or specifically for those attempting vaginal birth [22]. The rates of preterm delivery were also similar between the groups, and zero cases of uterine rupture were reported [21−23].…”

A Review of the Molecular Basis for Reduced Endometrial Receptivity in Uterine Fibroids and Polyps

“…In women with submucosal fibroids, myomectomy restores pregnancy rates to those similar of normal control patients (11). Similarly, a myomectomy in patients with intramural fibroids has been associated with higher pregnancy rates (5, 16, 17). In the future, less invasive therapies, such as targeted molecular therapy, may reduce the need for operative intervention.…”