Ultrasonographic prediction of the efficacy of GnRH agonist therapy beforelaparoscopic myomectomy

Study Objective, To assess ultrasonographic prediction of the efficacy of a dministration of a gonadotropin-releasing hormone (GnRH) analog before lapa roscopic myomectomy Design. Prospective, randomized study of women treated consecutively from S eptember 1994 to July 1996 (Canadian Task Force classification II. Setting. Endogyn Service, Private Endoscopic Associates, Naples, and Depart ment of Gynecologic and Pediatric Sciences, Reggio Calabria University, Cat anzaro, Italy. Patients, Sixty-seven infertile women with symptomatic uterine myomata, mai nly intramural, undergoing laparoscopic myomectomy. Interventions, Patients were prospectively randomized in two groups. Group A received preoperative administration of two injections of a depot formula tion of leuprolide acetate 28 days apart, and group B underwent direct surg ery In each group we studied the number, diameter, and echogenicity of larg er fibroids; resistance index of uterine arteries and myoma vessels; operat ing lime; and blood loss. Measurements and Main Results, The two groups did not significantly differ in baseline ultrasonographic parameters. Both blood loss (p <0.01) and oper ating time (p <0.05) were significantly lower in group A. However, operatin g time was significantly longer when the main myoma was markedly hypoechoic . Conclusion. Our data confirm the therapeutic efficacy of administration of a GnRH analog before laparoscopic myomectomy in reducing blood loss and dec reasing operating time in all cases except those with markedly hypoechoic f ibroids.