Reproductive outcome following abdominal myomectomy for a very large fibroid uterus.

Published on Jan 1, 2015in Journal of Obstetrics and Gynaecology0.807
· DOI :10.3109/01443615.2014.930097
Jyotsna Pundir15
Estimated H-index: 15
(Guy's and St Thomas' NHS Foundation Trust),
J. Kopeika1
Estimated H-index: 1
(Guy's and St Thomas' NHS Foundation Trust)
+ 5 AuthorsTarek El-Toukhy34
Estimated H-index: 34
(Guy's and St Thomas' NHS Foundation Trust)
AbstractThe aim of this study was to assess the long-term reproductive outcome following abdominal myomectomy in women with very large fibroid uteri. It is a retrospective study of 90 subfertile women with the main outcome measure of live-birth rate following spontaneous and assisted conception. Mean age of the study population was 37 ± 5 years and mean uterine size was 21 ± 6 weeks. During follow-up (mean 50 ± 10 months), 28 (31%) pregnancies occurred; 18 spontaneous and 10 following IVF. The live-birth rate was 20% and the miscarriage rate was 32%. Multivariate analysis demonstrated that the chance of live birth was significantly reduced with increasing female age at the time of surgery (OR = 0.67, 95% CI 0.51–0.86, p = 0.002). The perioperative blood transfusion rate was 30% and the incidence of major complications was 6%. Fertility after abdominal myomectomy for very large fibroid uteri is possible, and its major determinant is female age at the time of surgery.
#1Vito Cela (UniPi: University of Pisa)H-Index: 20
#2Letizia Freschi (UniPi: University of Pisa)H-Index: 11
Last. Nicola Pluchino (UniPi: University of Pisa)H-Index: 21
view all 7 authors...
Introduction: Laparoscopic myomectomy has recently gained wide acceptance but this procedure remains technically highly demanding and concerns have been raised about the increased blood loss and an higher risk of postoperative uterine rupture of the pregnant uterus. Objective: The aim of the present study is to evaluate the fertility and endocrine outcome in women underwent robot-assisted laparoscopic myomectomy (RALM). Methods: Data from 48 RALM performed in our department between the years 200...
27 CitationsSource
#1Togas Tulandi (McGill University)H-Index: 73
#2Khalid Akkour (McGill University)H-Index: 2
Last. Khalid Akkour (McGill University)H-Index: 1
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Reproductive surgery could be divided into surgery as a primary treatment for infertility, surgery to enhance in-vitro fertilisation outcome, and surgery for fertility preservation. A shift has occurred away from surgery as a primary treatment of infertility to surgery playing a crucial part in enhancing in-vitro fertilisation outcome and for fertility preservation. A normal uterine cavity is a prerequisite for implantation, and hysteroscopic correction of intrauterine pathology, including polyp...
16 CitationsSource
#1Xiaoxiao Catherine Guo (NIH: National Institutes of Health)H-Index: 2
#2James H. Segars (NIH: National Institutes of Health)H-Index: 57
Uterine fibroids, or leiomyoma, are benign tumors of the uterus that may cause severe pain, bleeding, and infertility (1). Fibroids affect a woman's quality of life, as well as her fertility and obstetrical outcomes. Fibroids affect approximately 35-77% of reproductive age-women (2-4), although the real prevalence is much higher since many fibroids may be asymptomatic. Nearing age 50, this likelihood may increase to 70-80% depending on the patient's ethnicity (3). Of particular note, Peddada et ...
51 CitationsSource
#1Mostafa Metwally (Ninewells Hospital)H-Index: 20
#2Ying Cheong (University of Southampton)H-Index: 29
Last. Andrew W Horne (Edin.: University of Edinburgh)H-Index: 39
view all 3 authors...
Background Fibroids are the most common benign tumours of the female genital tract and are associated with numerous clinical problems including a possible negative impact on fertility. In women requesting preservation of fertility, fibroids can be surgically removed (myomectomy) by laparotomy, laparoscopically or hysteroscopically depending on the size, site and type of fibroid. Myomectomy is however a procedure that is not without risk and can result in serious complications. It is therefore es...
80 CitationsSource
Women who wish to conceive are nowadays more likely to present with uterine fibroids, mainly because of the delay in childbearing in our society. The relationship between uterine fibroids and human reproduction is still controversial and counselling patients might sometimes be challenging. This paper is to assist those involved in the management of patients of reproductive age presenting with uterine fibroids. The interference of fibroids on fertility largely depends on their location. Submucous...
18 CitationsSource
#1Osamu Yoshino (UTokyo: University of Tokyo)H-Index: 31
#2Osamu Nishii (Teikyo University)H-Index: 16
Last. Toshihiko Hayashi (Teikyo University)H-Index: 3
view all 9 authors...
Abstract Background The relationship between fibroids and infertility remains a critical and unresolved question. During the implantation phase, it is known that uterine peristalsis is dramatically reduced, which is thought to facilitate implantation of the embryo to the endometrium. In the previous study, using a cine MRI mode, we found that less than half of the patients with intramural fibroids exhibited abnormal uterine peristalsis during the mid-luteal phase. In the present study, we furthe...
45 CitationsSource
#1Sotirios H. Saravelos (University of Sheffield)H-Index: 19
#2Junhao Yan (SDU: Shandong University)H-Index: 16
Last. Tin-Chiu Li (University of Sheffield)H-Index: 68
view all 4 authors...
background: Although uterine fibroids have been associated with spontaneous miscarriage, to our knowledge there have been no studies in the literature assessing their role in the recurrent miscarriage (RM) population. The aims of this study are to examine the impact of different types of fibroids on the pregnancy outcome of women with RM and to investigate to what extent resection of fibroids distorting the uterine cavity affects the outcome of a future pregnancy. methods: The study analysed ret...
57 CitationsSource
#1Jesse Y Obed (University of Maiduguri)H-Index: 2
#2Babagana Bako (University of Maiduguri)H-Index: 9
Last. Joel Y. MoruppaH-Index: 2
view all 6 authors...
Background: Abdominal myomectomy remains the mainstay of surgical management of uterine fibroids in our environment. However, its benefit in women aged 40 years and above remains debatable. Materials and Methods: An 11-year prospective study was conducted involving 98 women, aged 40 years and above, who had abdominal myomectomy for the treatment of uterine fibroid at the University of Maiduguri Teaching Hospital, Maiduguri. They were followed up regularly for 1–6 years to detect conception, reso...
11 CitationsSource
#1I. Roux (University of Paris-Sud)H-Index: 1
#2E. Faivre (University of Paris-Sud)H-Index: 9
Last. Xavier Deffieux (University of Paris-Sud)H-Index: 21
view all 6 authors...
Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 40 - N° 2 - p. 123-129
6 CitationsSource
Uterine fibroids are a major gynecologic disorder among women and commonly found in the infertile couple. Although numerous surgical techniques exist to destroy or remove these tumors, the role of such surgical procedures in the infertile woman has been heavily debated. The primary reason for this is a lack of evidence of a cause-and-effect relationship between fibroids and subfertility. However, review of the evidence suggests that submucous myomas and possibly intramural myomas both serve to d...
20 CitationsSource
Cited By2
#2Camille Adam (University of Limoges)
Last. Tristan Gauthier (University of Limoges)H-Index: 12
view all 4 authors...
Abstract null Many concerns have been raised for an optimal time interval between myomectomy and pregnancy as no specific guidelines does exist. This review aimed to study the time interval from myomectomy to pregnancy and occurrence of uterine rupture after myomectomy. We considered randomized controlled trials, cohort studies, retrospective studies to assess our primary objective, and case reports, cases series or letter to the editor for our secondary objective. All articles should deal only ...
Why is age a major determinant of reproductive outcomes after myomectomy in subfertile women?