Reproductive outcome after laparoscopic myomectomy in infertile women

OBJECTIVE: To assess reproductive outcome after laparoscopic myomectomies f or interstitial and/or subserosal myomas in infertile women with or without associated infertility factors. STUDY DESIGN: In this observational study, 91 women with infertility for on e year and at least one interstitial and/or subserosal myoma >20 mm were tr eated with laparoscopic myomectomy. All patients were mailed questions abou t fertility and pregnancy outcome. Cumulative pregnancy rates were calculat ed by the Kaplan-Meier method. The log rank rest and Cox's model were used for comparing the spontaneous pregnancy rate in patients with and without a ssociated infertility factors. RESULTS: The mean age of the patients was 35+/-4 years. The mean duration o f infertility was 44+/-33 months. Twenty-five patients (27.5%) had no assoc iated infertility factors, and 66 (72.5%) had one or more. The mean size of the largest myomas was 45+/-19 mm. The mean number of myomas removed was 2 .0+/-1.4. Eighty-six patients had laparoscopic myomectomy (94.5%), and five had laparoscopically assisted myomectomy (5.5%). There were no conversions to laparotomy. Ten patients were lost to follow-up (11.0%). Among the 91 p atients treated surgically, 81 (89.0%) of them were evaluated. Forty-three (53.1%) conceived, resulting in a total of 51 pregnancies. The two-year ove rall cumulative conception rate was 51.2% (95% confidence interval [Cl], 39 .2-63.2%). The two-year spontaneous pregnancy rate was 43.9% (95% CI, 32.1- 55.7%). This rate was 69.9% (95% CI, 50.3-89.5%) for patients with no assoc iated factors and 31.5% (95% CI, 18.4-44.6%)for patients with associated fa ctors (P<.001). This result was not affected by adjusting for age or durati on of infertility. CONCLUSION: Laparoscopic myomectomy seems to be a good procedure for patien ts with myomas and no of her infertility factors. In cases with associated infertility factors, the need for myomectomy has to be studied.