Smith, D. C., & Uhlir, J. K. (1990). Myomectomy as a reproductive procedure. American Journal of Obstetrics and Gynecology, 162(6), 1476-1482. https://doi.org/10.1016/0002-9378(90)90909-q
Smith DC, Uhlir JK. Myomectomy as a reproductive procedure. Am J Obstet Gynecol. 1990;162(6):1476-1482. doi:10.1016/0002-9378(90)90909-q
Smith, Donald C., and Jane K. Uhlir. "Myomectomy as a reproductive procedure." American Journal of Obstetrics and Gynecology, vol. 162, no. 6, 1990, pp. 1476-1482.
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Department of Obstetrics-Gynecology, Swedish Hospital Medical Center, Seattle, WA.
Myomectomy was followed by pregnancy in 16 of 32 women who tried
Half of the 32 women who tried to conceive after myomectomy became pregnant, in a case series of 64 myomectomies in 63 women. No woman had a major complication or needed a blood transfusion. Recurrent fibroids were detected in 4 of the 62 women with follow-up.
Key Findings
The series covered 64 myomectomies in 63 women aged 27 to 47 years (average 35.8). Infertility was not the primary indication for surgery in any woman.
Of 32 women who attempted pregnancy after surgery, 16 became pregnant. Twelve of those pregnancies produced term viable infants, two were ectopic and two ended in spontaneous abortion.
Half of the women who became pregnant were aged 35 or older, and 5 of the 16 were aged 40 or older. Total weight of fibroids removed did not correlate with pregnancy.
No woman had a major complication or needed a blood transfusion, and no case required hysterectomy or other procedures to control bleeding. Average hospital stay was 4 days.
Recurrent fibroids were detected in 4 of 62 women with follow-up data (6.4%), and 3 women required a further operation (4.8%).
Interpretation
This case series describes 64 myomectomies performed from 1981 to 1988. Uterine size or recent growth was the main reason for surgery in 58 of the 64 operations. Pregnancy results cover the 32 women who attempted pregnancy; 27 chose not to attempt it. The authors state that whether fibroids cause infertility was not addressed directly. Two of the women became pregnant by gamete intrafallopian transfer.
RRM Context
Restorative reproductive medicine aims to repair the body so that pregnancy stays possible. Myomectomy removes fibroids and keeps the uterus. The authors estimate that 20% to 25% of the women who wanted to attempt pregnancy or keep childbearing potential came by referral or for a second opinion. Other doctors had advised hysterectomy first or said no alternative existed.
Our editorial summary of this paper, not the article's abstract.
Abstract
This series of 64 myomectomies describes the indications, technique, and efficacy of the procedure; the majority of operations were performed on large multinodular uteri. Indications included enlarging pelvic mass, menorrhagia, anemia, and pregnancy wastage in women who wished to preserve reproductive capability. Although infertility was not the primary indication in any case, 32 patients were nulligravid. Only 10 patients were parous and 14 had a history of spontaneous abortion or pregnancy wastage. The average age of the patients was 35.8 years (range, 27 to 47 years). There were no major complications and no patients received blood transfusions. Follow-up revealed three patients with recurrent tumors necessitating repeat procedures. Successful pregnancies have occurred in 40% of those attempting pregnancy. It is concluded that successful myomectomy can be performed in most patients regardless of uterine size, thereby preserving reproductive potential.
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