Prognostic factors of reproductive outcome after myomectomy in infertile patients.
The objective of this study was to identify the prognostic factors for conception after myomectomy carried out in cases of infertility. A total of 91 infertile patients presenting at least one subserous or intramural myoma measuring >2 cm underwent myomectomy. The characteristics of the patients, myomata and associated infertility factors were collected in a uniform and systematic way. A postal questionnaire was sent to patients. For each of the various factors studied, the specific cumulative probability of spontaneous intrauterine conception was estimated using the Kaplan-Meier method. Multiple regression analysis was then carried out using Cox's proportional hazards model. The cumulative probability of spontaneous intrauterine conception at 2 years follow-up was 44% (95% confidence interval: 32-56%). The cumulative probability of conception was less after removal of a posterior or intramural myoma, after a sutured hysterotomy, and when accompanied by a male factor, associated tubal or ovulation pathology. The cumulative probability of conception was greater after ablation of myomata responsible for menometrorrhagia. The size, deforming effect on the cavity and age played no role in our sample. Our results indirectly suggest that post myomectomy adhesions could have an adverse effect on fertility. Myomata responsible for menometrorrhagia are also the cause of infertility. In the presence of an associated male, tubal or ovulatory factor, the results were poor and it was not possible to determine if a myomectomy should be performed in these cases in order to enhance fertility.
Service de chirurgie gynécologique (Pr. Dubuisson), Clinique universitaire Baudelocque, CHU Cochin - Saint Vincent de Paul, Paris, France. arnaud.fauconnier@cch.ap-hop-paris.fr
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Fauconnier
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JB
Dubuisson
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PY
Ancel
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Chapron
D000328:Adult; D005260:Female; D005306:Fertilization; D005500:Follow-Up Studies; D006801:Humans; D007247:Infertility, Female / Q000601:surgery*; D010535:Laparoscopy; D007889:Leiomyoma / Q000601:surgery*; D008297:Male; D011247:Pregnancy; D012044:Regression Analysis; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000601:surgery*