Determinants of reproductive outcome after abdominal myomectomy for infertility.
OBJECTIVE
To determine the effect of myomectomy as a therapy for infertility and to define the factors that influence reproductive outcome.


METHODS
Retrospective study of a case series.


METHODS
An academic department specializing in conservative surgery.


METHODS
A total of 138 infertile women who underwent first-line conservative surgical treatment at laparotomy for uterine leiomyomas over an 8-year period.


METHODS
Data were collected on baseline clinical characteristics, surgical details, and subsequent reproductive history.


METHODS
Cumulative pregnancy rates at 24 months according to selected clinical and fibroid characteristics.


RESULTS
Pregnancy occurred in 76 women. The 24-month cumulative probability of conception according to the Kaplan-Meier method was 87% in patients <30 years of age, 66% in patients 30-35 years of age, and 47% in patients >35 years of age. The pregnancy rates in women with and without minor infertility factors in addition to myomas were 56% and 71%, respectively, and those in women with <2 years versus > or =2 years of infertility were 84% and 51%, respectively. The size and site of the largest myoma and the total number of tumors removed did not influence the outcome.


CONCLUSIONS
Our results suggest a benefit of myomectomy in infertile patients. However, women should be counseled carefully before surgery because the determinants of outcome appear to be independent of treatment.
Vercellini
P
P
Clinica Ostetrica e Ginecologica Luigi Mangiagalli, University of Milano and Istituti Clinici di Perfezionamento, Italy. pgcros@imiucca.unimi.it
Maddalena
S
S
De Giorgi
O
O
Pesole
A
A
Ferrari
L
L
Crosignani
P G
PG
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007246:Infertility / Q000209:etiology / Q000601:surgery*; D007889:Leiomyoma / Q000150:complications / Q000601:surgery*; D011184:Postoperative Period; D011247:Pregnancy; D018873:Pregnancy Rate; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000150:complications / Q000601:surgery*