CHARLESTON, S.C. – Women who desire pregnancy after undergoing robotic-assisted myomectomy – including those with known infertility prior to the procedure – may have a good chance of conceiving following the procedure, findings from a retrospective case series have shown.
Of 198 women who underwent robotic myomectomy between 2006 and 2011 and who were followed for between 1 and 6.5 years, 52% attempted pregnancy, and 71% of those had a total of 81 pregnancies. A subset of 39% of the participants had known infertility prior to myomectomy, and of those, 62% achieved a total of 52 pregnancies, Dr. Lauren Rascoff reported at the annual meeting of the Society of Gynecologic Surgeons.
Of the 81 pregnancies, 38 (47%) occurred spontaneously, including 14 in the group with preoperative infertility, and 43 (53%) were achieved using assisted reproductive technology, including 39 in the infertility group, said Dr. Rascoff of Mount Sinai Medical Center, New York.
Of 40 deliveries that had occurred by the time of Dr. Rascoff’s presentation, 31 (78%) were done at term, including 19 in the infertility group, and 9 (22%) were preterm, including 8 in the infertility group. Most (37, or 92.5%) of the women were delivered by cesarean section, including 26 in the infertility group, and 3 (7.5%) involved a normal spontaneous vaginal delivery, including 1 in the infertility group.
One pregnancy was complicated by cesarean hysterectomy secondary to a placenta accreta, but no cases of uterine rupture occurred.
Eighteen pregnancies were ongoing, and 18 resulted in spontaneous abortion, including 14 in the infertility group. The rest, except for one molar pregnancy, ended as a result of elective termination or intrauterine fetal demise.
Participants were interviewed by phone using a 27-item survey about pregnancy attempts and outcomes before and after myomectomy, and about preoperative and postoperative infertility treatments. They had a mean age of 37 years, had a mean body mass index of 24.75 kg/m2, and were ethnically diverse. Parity ranged from 0 to 4.
On average, 3.3 fibroids with a mean weight of 332 g each were removed during the procedures. The mean operative time was 152 minutes.
The findings are important because the prevalence of fibroids in an unselected female population ranges from 5% to 25%, and fibroids account for 27% of uterine abnormalities in women attempting to become pregnant. The presence of fibroids is known to have adverse effects on implantation and pregnancy continuation, Dr. Rascoff said.
Although several studies have demonstrated the benefit of fibroid removal on fertility, few address pregnancy outcomes after robotic-assisted myomectomy, she noted.
The current findings are comparable to those of other series reported in the literature, she said.
Dr. Rascoff reported having no relevant financial disclosures.