Human Reproduction, Vol 13, 873-879, Copyright © 1998 by Oxford University Press
P Vercellini, S Maddalena, O De Giorgi, G Aimi and PG Crosignani
To obtain estimates of the effect of abdominal myomectomy on infertility,
information from studies published in the English language literature
between 1982 and 1996 was retrieved. Articles were identified through hand
and computerized searches using Medline. A total of 27 trials, all
published in peer-reviewed journals, was identified, of which four were
excluded from the analysis because of methodological limitations. All
studies were non-comparative and only nine were prospective. The sample
size was generally limited, the mean number of patients included being 49
and the mean number of infertile subjects 26. All patients were followed
for at least 12 months after surgery in 12 studies. The combined estimate
of pregnancy rates across prospective studies based on a total of 138
observed subjects was 57% [95% confidence interval (CI), 48-65%]. Time to
conception varied from a mean of 8 to 20 months. Survival analysis was used
in only three studies, with cumulative rates ranging from 57 to 67% at 1
year, and 63% at 5 years. The overall conception rate among seven
prospective studies in which only women with otherwise unexplained
infertility were recruited was 61% (95% CI, 51-70%) compared with 38% (95%
CI, 20-59%) in two prospective studies that included patients with causes
of infertility in addition to myomas (chi2(1) = 4.25, P = 0.04; mean
difference = 23%, 95% CI, 1-43%; OR = 2.47, 95% CI, 1.03-5.94). The
conception rate ranged from 58 to 65% in the three studies of women with
only intramural and/or subserous fibroids and were respectively 53 and 70%
in the two that considered only patients with submucous myomas. Data on
recurrence after myomectomy were reported in 13 articles, with rates
varying from 4 to 47%. According to the available evidence, slightly less
than two-thirds of women with uterine leiomyomas and otherwise unexplained
infertility conceived after myomectomy. However, comparison with expectant
management is needed before drawing definitive conclusions on the
effectiveness of this time-honoured conservative surgical procedure.
REVIEWS
Abdominal myomectomy for infertility: a comprehensive review
Clinica Ostetrica e Ginecologica Luigi Mangiagalli, Universita di Milano, Italy.
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