Laparoscopic Intracapsular Myomectomy in Women 40 Years Old and Over with Symptomatic Uterine Fibroids. A Pilot Study.

Jose Carugno,Ospan A Mynbaev,Giuseppe Trojano,Radmila Sparic,Andrea Tinelli,Antonio Malvasi,William H Catherino,Ioannis P Kosmas

doi:10.1055/s-0040-1722657

Abstract

Authors evaluated the impact of laparoscopic intracapsular myomectomy (LIM) in women 40 years of age and over with desire of future fertility compared with medical management of symptomatic fibroids, by a prospective cohort study in University affiliated Hospitals. This study includes a cohort of women 40 years of age and older with symptomatic intramural fibroids with desire of future fertility. Women with symptomatic fibroid uterus were offered to undergo LIM or medical management. They were encouraged to attempt conception either spontaneously or by assisted reproductive technology (ART) according to their individual preference. All women were followed for 2 years. Fibroid characteristics, pre- and post-surgical variables, including surgical complications, days of hospitalization, pregnancy rate, and obstetrical outcomes were collected. A total of 100 patient were included in the analysis. Fifty patients were assigned to the LIM group and 50 to the medical treatment group (MT). Groups were similar regarding age (43.5 ± 2.4 and 43.5 ± 2.4, p = 0.99), body mass index (23.8 ± 3.1 and 24.2 ± 3.1, p = 0.54), parity (0.46 ± 0.09 and 0.58 ± 0.09, p = 0.37), fibroid number (1.38 ± 0.6 and 1.46 ± 0.6, p = 0.53), and fibroid size (5.92 ± 1.62 cm vs. 5.94 ± 1.49 cm, p = 0.949). Of the patients who underwent LIM, 62% conceived within the study period compared with 56% in the control group ( p = 0.54). Pregnancy was achieved by ART in 44% of the patients of the LIM group and 30% in control group. There was no significant difference in pregnancy rates among the two groups regarding spontaneous pregnancy rate ( p = 0.332), nor in pregnancies obtained by ART with own eggs ( p = 0.146) and oocyte or embryo donation ( p = 0.821). The take home baby rate was 65% (20/31) in the LIM group and 61% (17/28) in the control group ( p = 0.7851). Both groups had similar rate of miscarriage ( p = 0.748). Patients 40 years old and over with symptomatic fibroid uterus who undergo LIM have similar subsequent fertility and obstetrical outcomes than women treated with medical management. LIM has no detrimental impact on future fertility in women 40 years old and over.

Highlights

Laparoscopic Intracapsular Myomectomy in Women 40 Years Old and Over with Symptomatic Uterine Fibroids
The American Society of Reproductive Medicine (ASRM) stated that there is insufficient evidence to determine that a specific myoma size, number, or location is associated with adverse fertility outcomes in asymptomatic patients, acknowledging that there is insufficient evidence indicating that myomectomy in asymptomatic women, reduces pregnancy loss rates, unless the fibroid is distorting the uterine cavity.[6]
The 100 patients were distributed in the two groups, with mean age of 43.56 Æ 2.45 for the laparoscopic intracapsular myomectomy (LIM) group and 43.58 Æ 2.46 for medical treatment group (MT) group

Summary

Introduction

Laparoscopic Intracapsular Myomectomy in Women 40 Years Old and Over with Symptomatic Uterine Fibroids. Uterine fibroids or leiomyomas are common benign tumors that cause anatomical disruption of the uterine architecture, leading to symptoms such as heavy or prolonged menstrual bleeding, pelvic pain, infertility, and recurrent pregnancy loss Their effect on fertility depends on the location, with intramural and submucosal fibroids having the most significant negative impact.[1,2]. The American Society of Reproductive Medicine (ASRM) stated that there is insufficient evidence to determine that a specific myoma size, number, or location (excluding submucosal myomas or intramural myomas impacting the endometrial cavity) is associated with adverse fertility outcomes in asymptomatic patients, acknowledging that there is insufficient evidence indicating that myomectomy in asymptomatic women, reduces pregnancy loss rates, unless the fibroid is distorting the uterine cavity.[6]

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