Laparoscopic myomectomy and futher reproductive outcomes.

Abstract

Uterine fibroids are one of the most common tumors in women worldwide. Considering the negative impact of uterine fibroids on pregnancy in women of reproductive age, myomectomy is the operation of choice. We examined reproductive outcomes in patients undergoing laparoscopic myomectomy for various types of fibroid nodules. Objective: To evaluate reproductive outcomes in patients with infertility and uterine fibroids after laparoscopic myomectomy. Materials and methods: The study included 38 women aged 18 to 45 years with uterine fibroids and infertility. All patients underwent elective laparoscopic myomectomy. The study was conducted among patients who applied routinely to the St. Luke's Clinical Hospital of St. Petersburg in 2021. At least 2 years of follow-up after possible surgical treatment was acceptable as a time interval for conception. Pregnancy was confirmed by visualizing the fertilized egg in the uterine cavity. Data on the type and number of laparoscopic myomectomies and the characteristics of myoma nodes, such as their number, size and location, were collected from medical records. Obstetric and gynecological history data was also obtained, including the number and outcomes of pregnancies. Results: The study found that of 38 patients with uterine fibroids and infertility, 24 women (63%) became pregnant within 2 years after laparoscopic myomectomy. Of these, 13 (54.1%) were delivered by cesarean section, and 11 (45.9%) were delivered naturally. Of the 5 women with subserous fibroid nodes (FIGO type 7), 5 (100%) became pregnant. Of the 19 patients with intramural subserous nodes (FIGO types 5 and 6), 11 (58%) became pregnant. Of the 24 women with intramural nodes (FIGO type 4), 8 (33%) became pregnant. In 5 (100%) women who became pregnant after removal of the subserous node (FIGO type 7), vaginal delivery was performed. In 7 (63.6%) patients who became pregnant after removal of an intramural-subserous node (FIGO types 5 and 6), delivery was performed by cesarean section, in 4 (36.4%) by natural delivery. In 6 (75%) women who became pregnant after removal of an intramural node (FIGO type 4), delivery was performed by cesarean section, in 2 (35%) by natural delivery. Of 14 women suffering from infertility and having only 1 fibroid node, 11 became pregnant (78.5%), of 19 patients with 2 fibroids, 11 (58%) became pregnant, of 5 women who had 3 or more fibroid nodes became pregnant 2 (40%). Of the 11 women who became pregnant after myomectomy of 1 node, 5 (45.4%) had a cesarean section and 6 (54.6%) had a natural delivery. Of the 11 women who became pregnant after removal of 2 fibroids, 6 (54.5%) had a cesarean section, 5 (45.5%) had a vaginal delivery, of 2 women who became pregnant after removal of 3 or more fibroids, 2 (100%) were performed by caesarean section. In addition, we found that out of 4 women who had fibroids measuring less than 3 cm, only 1 (25%) became pregnant; out of 9 patients with fibroids from 3 to 5 cm, 7 (29%) became pregnant; out of 25 patients with 16 (67%) became pregnant with fibroids larger than 5 cm. In the only woman who became pregnant after myomectomy of a node less than 3 cm, delivery was performed by cesarean section. 4 (57%) patients who became pregnant after removal of fibroids measuring 3 to 5 cm had a cesarean section delivery, and 3 (43%) had a natural delivery. In 8 (50%) patients who became pregnant after removal of a node measuring more than 5 cm, delivery was performed by cesarean section, in 8 (50%) by natural delivery. Conclusions: Depending on the size, number and location, uterine fibroids can cause infertility. Our study demonstrates that laparoscopic myomectomy improves reproductive outcomes in women with subserosal, intramural-subserosal, and intramural myomatous nodules. After removal of nodes larger than 5 cm, the pregnancy rate was significantly higher than after removal of nodes smaller than 5 cm. In addition, the pregnancy rate in this observation period was higher in patients after removal of a single uterine fibroid, compared with women with 2 and more myomatous nodes. After removal of the subserous nodes, delivery was carried out naturally; after removal of the intramural and subserosal-intramural nodes, in most cases the tactics of delivery by cesarean section were chosen. In the groups of women who became pregnant after removal of a node from 3 to 5 cm and more than 5 cm, the rate of delivery by cesarean section and vaginally was approximately equal. After myomectomy of a node less than 3 cm, delivery was carried out naturally. In the groups of women who became pregnant after removal of 1 and 2 nodes, the rate of surgical and natural delivery was approximately the same, and in the group of patients with 3 or more nodes, a cesarean section was performed in all cases. Key words: uterine fibroids, myomectomy, infertility.