FERTILITY AND PREGNANCY OUTCOME AFTER MYOMECTOMY IN STERILITY PATIENTS

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.