Hysteroscopic resection of submucosal myomas in patients with infertility

BACKGROUND: Submucosal myomas are associated with infertility, and may be t reated by hysteroscopic resection, Improvement of the menstrual pattern aft er surgery has been examined and compared with pregnancy rate in a group of menorrhagic women with primary (n = 24) and secondary (n = 35) infertility , METHODS: The entire patient group (n = 59) was managed between January 19 90 and September 1998, The submucosal myomas were intracavitary (n = 15), i ntramural class 1 (n = 34) and intramural class 2 (n = 10), and none was mu ltiple submucosal myoma, The mean (+/- SD) age was 36.6 +/- 4.6 years; mean myoma size was 24.5 +/- 13.3 mm; mean duration of the procedure was 40 +/- 23 min; and mean follow-up was 26 +/- 18.8 months. Thirty-five patients ha d one or more associated infertility factors. RESULTS: An improvement in cl inical symptoms was observed in 62% of patients. Sixteen patients (27%) con ceived, and of these only six (10%) delivered at term. The pregnancy rate w as significantly better when myoma was the exclusive aetiology of infertili ty (41.6%), and when the lesion was greater than or equal to 50 mm in size (57.1%). CONCLUSIONS: Hysteroscopic myomectomy appears safe, and is effecti ve in the control of menstrual disorders. However, the effect on infertilit y seems limited, particularly in terms of delivery rate. The advanced age o f the patients may partly explain these results.