Pregnancies and births in women with previous abdominal myomectomy

Abstract

Background: Uterine leiomyoma may cause pelvic symptoms and may also interfere with the reproductive desires of many women. Consequently, some women may undergo myomectomy as a fertility sparring method to relieve symptoms or as a method to improve their fertility. Objective: We aimed to assess pregnancies and deliveries in women with previously myomectomy both in spontaneous pregnancies and with use of assisting reproductive techniques. Also, we aimed to asses if the reproductive prognosis differed between different surgical approaches. Study design: In this historical cohort study we collected data regarding myomectomies, pregnancies, use of assisting reproductive techniques and births from national health registries. All Danish women were followed from 1996 through 2017. Results: Of 5.281 women undergoing myomectomy, 97% had one and 3% had two or more myomectomies. Median age at first surgery was 38.5 years (interquartile range 34.1-44.6 years). Of 5.430 myomectomies conducted, 71% were done by laparotomy and 29% by laparoscopy. Of the 5.281 women treated with myomectomy, 1.586 (30%) became pregnant and 1.145 (22%) gave birth. In the entire cohort of 5.281 women, 1.056 (20%) were treated with assisting reproductive techniques. Of these 1.056 women, 659 (62%) got pregnant and 461 (44%) delivered. Median time from surgery to pregnancy was 1.2 years. Significantly more women became pregnant and gave birth when treated with laparotomy as compared to laparoscopy. However, the effect was only significant for women younger than 30 years or older than 40 years at first surgery. Conclusion: As the proportion of women attempting pregnancy was unknown, the overall figure of 30% pregnancy rate is a minimum estimate of the real chance of achieving pregnancy after myomectomy.