Comparison of Long-Term Fertility Outcomes after Myomectomy: Relationship with Number of Myomas Removed

Abstract

Study ObjectiveTo determine if the number of myomas removed during myomectomy for symptomatic relief affects long-term fertility outcomes in reproductive-aged women. DesignRetrospective cohort survey study (Canadian Task Force classification II-2). SettingUniversity hospital. PatientsOne hundred forty-four patients who underwent myomectomy for symptomatic myomas and attempted to conceive afterward. InterventionQuestionnaire mailed to reproductive-aged women who received robotic, laparoscopic, or abdominal myomectomy. Measurements and Main ResultsPatients with >6 myomas removed were less likely to achieve pregnancy after myomectomy than patients with ≤6 myomas removed (22.9% vs 70.8%, respectively; p < .001). To achieve pregnancy, 45% of those with >6 myomas removed (vs 17.6% of those with ≤6 myomas removed) relied on fertility treatment (clomiphene citrate, letrozole, intrauterine insemination, or in vitro fertilization). Of those with >6 myomas removed who became pregnant, 45.5% had a term birth, 45.5% miscarried, and 9.1% had an ectopic pregnancy. Of those with ≤6 myomas removed who became pregnant, 61.8% had a term birth, 23.5% had a preterm birth, and 13.2% miscarried. ConclusionThe number of myomas removed during myomectomy significantly affects fertility. Women with >6 myomas removed were less likely to become pregnant, more likely to require fertility treatment, and less likely to have a term birth when compared with women with ≤6 myomas removed.