Uterine leiomyomata and sterility: therapy with gonadotropin-releasing hormone agonists and leiomyomectomy.
The aim of this study was to obtain data about the pregnancy rate in patients with uterine leiomyomata after treatment with gonadotropin-releasing hormone (GnRH) agonists followed by myomectomy. Between 1987 and 1993, 61 patients with uterine leiomyomata and sterility underwent 6 months' GnRH agonist treatment, in part with a surgical intervention. Sixty-two per cent of the patients suffered from concomitant endometriosis. After hormonal therapy 41 patients underwent a myomectomy. According to sonographic and clinical criteria, there was no indication for the enucleation of the leiomyomata for the remaining 20 patients. Owing to the combined therapy, consisting of primary treatment of uterine leiomyomata with GnRH agonists, followed by surgical intervention, 25 patients (41%) suffering from long-term sterility (average 4 years) became pregnant. An early abortion occurred in only three cases (12%). No patient who underwent a myomectomy developed new myomata during the following pregnancy. Four patients suffering from a single leiomyoma became pregnant within the first 3 months after myomectomy, all of them conceiving spontaneously. Considering the high rate of spontaneous conceptions and the low abortion and complication rates during pregnancy, the combined therapy of GnRH agonists followed by myomectomy represents a major step forwards in the effective treatment of sterility in patients with uterine leiomyomata.
Kuhlmann
M
M
Department of Gynecology and Gynecological Oncology, University of Essen, Germany.
Gärtner
A
A
Schindler
E M
EM
Regidor
P A
PA
Bühler
K
K
Schindler
A E
AE
D000281:Administration, Intranasal; D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000627:therapeutic use*; D002064:Buserelin / Q000008:administration & dosage / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000627:therapeutic use; D017273:Goserelin / Q000008:administration & dosage / Q000627:therapeutic use; D006728:Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D007273:Injections, Intramuscular; D007889:Leiomyoma / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D016729:Leuprolide / Q000008:administration & dosage / Q000627:therapeutic use; D017274:Nafarelin / Q000008:administration & dosage / Q000627:therapeutic use; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D013997:Time Factors; D017329:Triptorelin Pamoate / Q000008:administration & dosage / Q000627:therapeutic use; D014594:Uterine Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000601:surgery
D018931:Antineoplastic Agents, Hormonal; D006728:Hormones; D017329:Triptorelin Pamoate; D017273:Goserelin; D017274:Nafarelin; D007987:Gonadotropin-Releasing Hormone; D016729:Leuprolide; D002064:Buserelin