Fertility and pregnancy outcome after myomectomy

Objective: Myomas can be associated with an increased rate of spontaneous p regnancy loss, premature delivery, and placental insufficiency. Indications for surgery include complications, rapid growth, infertility, and early pr egnancy loss. We evaluated pregnancy outcome in patients after myomectomy. Methods: We reviewed pregnancy outcomes in all 77 patients who underwent my omectomy between 1993 and 1997. Myomectomy was performed via laparotomy in 42 women, laparoscopically in 24, hysteroscopically in 9, and at cesarean s ection in 2 women. Results: 49 of the 77 patients attempted to become pregnant after myomectom y and 20 (41%) conceived by 1999. The pregnancy rate was inversely associat ed with the number of myomas removed. Of the 28 patients in whom a single m yoma was removed, 15 (54%) became pregnant as compared with 2 of the 11 (18 %) with removal of more than two fibroids (p = 0.004). There was no associa tion between the pregnancy rate and the size of the removed myomas. Seven o f 13 patients after laparoscopic myomectomy became pregnant compared with 1 1 of 30 after open surgery. Twenty patients had a total of 35 pregnancies. Nine patients had 16 pregnancies with complications (4 with spontaneous abo rtion, 4 with preterm delivery, 3 with premature rupture of the membranes, 2 with failure to progress, 2 with intrauterine growth restriction, 1 with placental abruption). Fifteen patients (79%) were delivered vaginally. Ther e was no case of uterine rupture. 75% of the patients delivered by cesarean section had intramural myomas. Conclusion: Myomectomy should be considered in women with myomas who wish t o become pregnant, particularly if the myomas are large or multiple. The su rgical approach will depend on the location, number and size of the myomas.