Verkauf, B. S. (1992). Myomectomy for fertility enhancement and preservation. Fertility and Sterility, 58(1), 1-15. https://doi.org/10.1016/s0015-0282(16)55128-0
Verkauf BS. Myomectomy for fertility enhancement and preservation. Fertil Steril. 1992;58(1):1-15. doi:10.1016/s0015-0282(16)55128-0
Verkauf, B. S. "Myomectomy for fertility enhancement and preservation." Fertility and Sterility, vol. 58, no. 1, 1992, pp. 1-15.
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About 6 in 10 women with fibroids alone conceived after myomectomy
About 6 out of 10 women with fibroids alone conceived after myomectomy, a 1992 review of seven surgical series found. Fibroids alone meant no other apparent cause of infertility. The series covered 234 women in all. Follow-up in every series exceeded 10 months.
Key Findings
Among women who had myomectomy with no other apparent cause of infertility, 59.5% conceived afterward. Follow-up in all series exceeded 10 months.
Of women without a history of infertility before myomectomy, 57% conceived afterward. Of women with recurrent pregnancy wastage, 69% conceived.
Of women who were infertile and had other factors treated along with the fibroids, 50% became pregnant.
An earlier literature review of 1,941 women cited here found fetal wastage fell from 41% before myomectomy to 19% after.
Approximately 25% of women undergoing myomectomy may have recurrent fibroids during their lifetime. Most recurrences come late enough to leave time to conceive.
Interpretation
This review pooled seven surgical case series, plus the author's own patients. The author sees the pattern as support for myomectomy in women whose infertility has no other cause. Fibroids alone were rare. Only 1% of the author's 339 infertility surgeries from 1981 to 1990 needed only a myomectomy. The author calls the pattern promising and recommends further study to confirm it.
RRM Context
Fibroids are a structural finding. A fertility evaluation can find them. The pooled series checked for other causes first. Myomectomy rebuilds the uterus. It also protects the pelvic area, with care to limit scarring. Restorative reproductive medicine treats the cause an evaluation finds. Women with no other cause found have undiagnosed infertility. A full evaluation includes the male partner too.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To review, evaluate, and synthesize current published reports assessing the value of abdominal myomectomy in infertile women and those desiring to preserve fertility potential.
Data Identification
Major studies dealing with myomectomy were identified through Medline Searches.
Study Selection
Those papers reporting the results of myomectomy, factors influencing them, and potential future innovations were obtained.
Results
More than half of women not previously pregnant and undergoing myomectomy to preserve childbearing capacity for treatment of recurrent pregnancy wastage or previous infertility conceive. The long duration of infertility before surgery, absence of other factors to explain their not conceiving, and short time interval subsequent to surgery in which conception occurs suggests myomectomy has value in treatment of patients with leiomyomata and otherwise unexplained infertility. The operation carries acceptable risk. Approximately 25% of women undergoing myomectomy have recurrent leiomyomata, but most recurrences are sufficiently delayed to allow adequate opportunity for conception.
Conclusions
Abdominal myomectomy is an appropriate alternative to hysterectomy for most women who wish to preserve childbearing potential or enhance it. For the future, myomectomy by endoscopic techniques may hold similar potential.
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