R. Sudik et al., FERTILITY AND PREGNANCY OUTCOME AFTER MYOMECTOMY IN STERILITY PATIENTS, European journal of obstetrics, gynecology, and reproductive biology, 65(2), 1996, pp. 209-214
Objectives: To examine total pregnancy rate, pregnancy rate in relatio
n to pretreatment with GnRH-analogues, the frequency of myoma recurren
cies and the influence of size, number and localization of removed myo
mata on pregnancy rate and outcome in infertility patients after myome
ctomy. Study design: A comparative, retrospective non-randomized clini
cal study involving 67 patients with desire for children and no other
recognizable infertility factor. Myomectomy had been performed between
1985 and 1993. Most patients had been operated by laparotomy using mi
crosurgical instruments and techniques. Thirty-three patients had been
treated with a GnRH agonist for usually 3 months, and in 34 patients
the operation was performed without pretreatment. Patients were follow
ed up to June, 1994. All patients were mailed a questionnaire and invi
ted to an ultrasound examination. Results: Thirty-nine of the 67 patie
nts (58.2%) became pregnant, and a total of 51 pregnancies were observ
ed. Of the women who actually conceived, 61.5% did so within the first
year. There was no significant difference in pregnancy rates between
patients who had been pretreated with GnRH agonists and those who had
not. However, 1 year after the operation the group of GnRH-treated wom
en was significantly overrepresented among those already pregnant (P =
0.02). Sonografical examination revealed in 31 out of the 67 patients
(46.3%) recurrent myomata > 1 cm in diameter. There was no statistica
lly significant difference in the pregnancy rates between patients wit
h and without recurrencies. However, there was a significant tendency
toward a loss or short duration of the pregnancy due to spontaneous ab
ortion and premature delivery in patients with recurrent or persistent
myomata (P < 0.01). Pregnancy rate was significantly lower in patient
s with more than five myomata removed (P < 0.001). In the group with a
larger myoma volume the pregnancy rate was significantly higher than
in the group with the smaller one (P < 0.01), possibly indicating that
the size on removal of myomata is an important factor for infertility
patients. Concerning the localization of the removed myomata, no stat
istically significant difference was found in the pregnancy rates betw
een various localizations. Of the 51 pregnancies, 31 (60.8%) led to a
delivery, vaginal in 13 cases (41.9%) and 18 times by Caesarean sectio
n (58.1%). Of the pregnancies that were lost, 39.2% were due to sponta
neous abortion or ectopic pregnancy. Conclusions: Our study supports r
eports on the benefits of myomectomy, performed with the appropriate t
echnique, in patients with otherwise unknown cause of infertility. It
shows, additionally, that characteristics of myomata, such as number a
nd size, may influence postmyomectomy pregnancy rates.