Laparoscopic myomectomy in patients with uterine myomas associated with infertility.
Although myomectomy is widely accepted in women of childbearing age who wish to retain their fertility, the extent to which myomas affect fertility and whether their removal improves this remain unclear. This study aimed to elucidate the favourable surgical approach in women with uterine myomas and infertility. This retrospective, follow-up study was carried out in three centres in Germany. Data on women who had undergone myomectomy via laparoscopy, laparotomy or conversion to laparotomy in 2000-04 were collected and analysed. Fertility outcome after myomectomy was assessed by follow-up postal questionnaire in a subgroup of women with myoma-associated infertility. Data on 159 women with otherwise unexplained infertility were included (mean age 35 years (range 17-47), mean number of myomas 2.4 (range 1-8) and mean myoma size 6.1 cm (range 0.5-20)). Women who underwent laparoscopy had fewer complications. 39.6% (63/159) of women completed the questionnaire, which showed that the pregnancy rate after myomectomy was 46% in this group. No uterine rupture occurred. Laparoscopy is associated with fewer postoperative complications and since no preoperative or intraoperative factors seem to influence the fertility outcome in women with uterine myomas, it is the treatment of choice in these patients.
Department of Obstetrics and Gynecology , Justus-Liebig-University of Giessen, Germany. andreas.hackethal@gyn.med.uni-giessen.de
Andreas
A
Hackethal
Anne
A
Westermann
Garri
G
Tchartchian
Frank
F
Oehmke
Hans-Rudolf
HR
Tinneberg
Karsten
K
Muenstedt
Bernd
B
Bojahr
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D005260:Female; D005858:Germany; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology*; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D007813:Laparotomy; D007889:Leiomyoma / Q000601:surgery*; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000601:surgery*; D014597:Uterine Rupture; D055815:Young Adult