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Abstract
Fibroids are the most common gynecological pathology in reproductive aged women and contribute to 2-3% of infertility cases. After hysteroscopic removal of submucosal FIGO 0 and I fibroids, pregnancy rates of 60% to 90% can be achieved. Pregnancy rates after non-hysteroscopic removal of subserosal FIGO V and VI fibroids remain controversial. We examined all myomectomies per laparoscopy/laparotomy for FIGO V and VI fibroids performed at the Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, from 2012 to 2021. All women with primary and secondary infertility between the ages of 18 and 40years with 1-3 subserous fibroids without additionally identified causes for infertility were included. The outcome was the clinical pregnancy rate within 12months after a postoperative non-conception window. A logistic regression model was used to assess associations between patient characteristics and postoperative pregnancy rates. The association was estimated as odds ratio (OR) with the respective 95% confidence interval (CI). We included a total of 80 women with a median age of 34.5years (IQR, 31.4-37.8). Of those, 42 patients (52.5%) had primary infertility and 38 patients (47.5%) had secondary infertility. Fibroid size ranged from 2 to 30cm with a median size of 7.5cm. Pregnancy occurred in 36 patients (45.0%) at a median of 4months (IQR 3.0-7.0) after initial postoperative 6months, where pregnancy was permitted. Age (OR 0.77, 95% CI 0.67-0.88) and fibroid size (OR 1.25; 95% CI 1.072-1.446) were significantly associated with the occurrence of a clinical pregnancy. In this cohort of infertile women of reproductive age with FIGO V and VI fibroids, almost half became spontaneously pregnant within 12months after a postoperative non-conception window of myomectomy per laparoscopy/laparotomy. Patients with larger fibroids were more likely to conceive after myomectomy.
Highlights
Uterine fibroids are the most common gynecological pathology in reproductive aged women with an estimated lifetime prevalence of up to 70% [1, 2]
Laparoscopy was performed in the majority of patients (63.7%, n = 51), whereas 36.3% (n = 29) of patients underwent laparotomy
In a binary logistic regression model (Table 1), the following two parameters were significantly associated with clinical pregnancy in the univariable and the multivariable model: patient age (adjusted OR 0.718, 95% CI 0.608–0.849; Table 1 Patient and fibroid characteristics and associations with clinical pregnancy estimated as odds ratio (OR) with 95% confidence interval
Summary
Uterine fibroids are the most common gynecological pathology in reproductive aged women with an estimated lifetime prevalence of up to 70% [1, 2]. They are benign tumors that often remain asymptomatic, uterine fibroids are a notable cause of recurrent pregnancy loss and contribute to 2–3% of all cases of infertility [3, 4]. One hypothesis suggests that the mechanical deformation of the uterine cavity may hinder the transport of germ cells and embryos, subsequently impairing implantation [5, 6] Another hypothesis posits that fibroids could alter the expression patterns of angiogenic factors (such as basic fibroblast growth factor and platelet-derived growth factor) [7, 8]. Pregnancy rates of up to 60–89.2% can be achieved with hysteroscopic myectomy [10, 11]
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