Reproductive outcome before and after laparoscopic or abdominal myomectomy for subserous or intramural myomas

Objectives: To analyze the reproductive outcome before and after myomectomy in patients with subserous or intramural myomas, and to assess the factors influencing pregnancy rate after myomectomy. Study design: Out of 128 patients submitted to myomectomy, we considered eligible for this study only the 41 patients wishing to conceive after surgery and who did not present any plausible infertility factor, apart from the removed myomas. We have evaluated the pregnancy outcome prior to and following myomectomy, and analyzed the correlation between conception rate after surgery and patient’s age at the time of the surgery, type of surgery, number and size of the myomas, location of the largest fibroid and previous pregnancies. Results: Nineteen patients had been submitted to abdominal (group A) and 22 to laparoscopic myomectomy (group B). Prior to surgery, 28 pregnancies had occurred in 14 of the 41 patients, with a miscarriage rate of 57.1%. Following surgery 29 pregnancies occurred in 25 patients (60.9%), pregnancy rate being similar in both groups. The postoperative delivery rate was 86.2% whereas the miscarriage rate was reduced to 13.8% (P<0.001). Overall, 60% of deliveries were vaginal. No cases of ectopic pregnancy or uterine rupture occurred. Those patients who conceived after surgery were significantly younger (32.36±4.06 years versus 35.88±3.57 years; P=0.0073), and their removed myomas were significantly larger (5.80±2.69 cm versus 4.28±1.54 cm; P=0.0274). Furthermore, a multivariate analysis shows that, apart from age and diameter, the probability of conceiving after myomectomy is higher in case of intramural myomas (intramural versus subserosal: OR 12.382, 95% CI: 1.61–95.22) or laparoscopic surgery (laparoscopy versus laparotomy: OR 14.062, 95% CI: 1.40–141.15). Conclusions: Our results suggest that myomectomy significantly improves pregnancy outcome in patients with subserous or intramural fibroids, probably removing a plausible cause of altered uterine contractility or blood supply. The main determinants of pregnancy rate after surgery are patient age, diameter and intramural localization of the myomas and type of surgery.