Abstract
Background
Myoma is the most common benign tumor in women of childbearing age, with a high frequency in Afro-Caribbean than in other women. Depending on their number, size and location, myomas are suspected to be a cause of infertility. Conservative treatment by myomectomy is possible for symptomatic patients wishing to preserve their fertility.
Purpose
The aim of this study was to evaluate the fertility of patients undergoing myomectomy in the University Hospital of Pointe-à-Pitre, Guadeloupe.
Methods
We conducted a retrospective study including all patients under age 42 who had conservative surgery from January 1st, 2005 to December 31st, 2009. The main judgment criteria were the occurrence of postoperative pregnancy and its outcome.
Results
Of 297 operated patients, 220 were interviewed by phone (74.1 %), 124 (56.3 %) had tried to obtain a pregnancy and 54 patients (43.5 %) had 66 pregnancies (59.1 % being live births and 25.8 % miscarriages). For fertility after surgery, univariate analysis identified the number (more than 6, P = 0.0027) and an intramural location (P = 0.027) of myomas as negative factors and multivariate analysis identified age (over 35 years, RR = 2.45) and the association of other causes of infertility (RR = 2.21) as negative factors for pregnancy.
Conclusion
The modest conception rate (43.5 %) after myomectomy among those women trying to obtain a pregnancy may be linked to the specificities of our population, and in particular its relatively high age and the frequent association of multiple causes of infertility.
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References
Bendifallah S, Levaillant J-, Fernandez H (2011) Fibrome et fertilité. EMC—Gynécologie-Obstétrique 47:1–25
Robboy SJ, Bentley RC, Butnor K, Anderson MC (2000) Pathology and pathophysiology of uterine smooth-muscle tumors. Environ Health Perspect 108:779–784
Lumbiganon P, Rugpo S, Phandhu-Fung S, Laopaiboon M, Vudikamraska N, Werawalakul Y (1995) Protective effect of depot medroxyprogesterone acetate on surgically treated uterine leiomyomas: a multicentre case–control study. Br J Obstet Gynaecol 103:909–914
Marshall LM, Spiegelman D, Barbieri RL, Goldman MB, Manson JE, Colditz GA, Willett WC, Hunter DJ (1997) Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol 90:967–973
Day Baird D, Dunson DB, Hill MC, Cousins D, Schectman JM (2003) High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Obstet Gynecol 188:100–107
Stovall DW, Parrish SB, Van Voorhis BJ (1998) Uterine leiomyomas reduce the efficacy of assisted reproduction cycles: results of a matched follow-up study. Hum Reprod 13:192–197
Buttram VCJ, Reiter RC (1981) Uterine leiomyomata: etiology, symptomatology and management. Fertil Steril 36:433–445
Verkauf BS (1992) Myomectomy for fertility enhancement and preservation. Fertil Steril 58:1–15
Bulletti C, De Ziegler D, Polli V, Flamigni C (1999) The role of leiomyomas in infertility. J Am Assoc Gynecol Laparosc 6:441–445
Fernandez H (2011) Actualisation de la prise en charge des myomes—introduction. J Gynecol Obstet Biol Reprod 40:856
Dubuisson JB (2005) Informations utiles sur le fibrome utérin. Imagerie de la Femme 15:158–160
Legendre G, Brun J-, Fernandez H (2011) Place des myomectomies en situation de conception spontanée ou chez la femme désireuse de préserver sa fertilité. J Gynecol Obstet Biol Reprod 40:875–884
Tulandi T, Murray C, Guralnick M (1993) Adhesion formation and reproductive outcome after myomectomy and second-look laparoscopy. Obstet Gynecol 82:213–215
Mais V, Ajossa S, Piras B, Guerriero S, Marongiu D, Melis GB (1995) Prevention of de-novo adhesion formation after laparoscopic myomectomy: a randomized trial to evaluate the effectiveness of an oxidized regenerated cellulose absorbable barrier. Hum Reprod 10:3133–3135
Takeuchi H, Kitade M, Kikuchi I, Shimanuki H, Kumakiri J, Takeda S (2008) Influencing factors of adhesion development and the efficacy of adhesion-preventing agents in patients undergoing laparoscopic myomectomy as evaluated by a second-look laparoscopy. Fertil Steril 89:1247–1253
Diamond MPFM (2001) Clinical implications of postsurgical adhesions. Hum Reprod Update 7:567–576
Palomba S, Zupi E, Russo T, Falbo A, Marconi D, Tolino A, Manguso F, Mattei A, Zullo F (2007) A multicenter randomized, controlled study comparing laparoscopic versus minilaparotomic myomectomy: short-term outcomes. Fertil Steril 88:942–951
Shokeir T, El-Shafei M, Yousef H, Allam A-, Sadek E (2011) Submucous myomas and their implications in the pregnancy rates of patients with otherwise unexplained primary infertility undergoing hysteroscopic myomectomy: a randomized matched control study. Fertil Steril 96:800
Pritts EA, Parker WH, Olive DL (2009) Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril 91:1215–1223
Somigliana E, Vercellini P, Daguati R, Pasin R, De Giorgi O, Crosigniani PG (2007) Fibroids and female reproduction: a critical analysis of the evidence. Hum Reprod Update 13:465–476
Vercellini P, Maddalena S, De Giorgi O, Aimi G, Crosignani PG (1998) Abdominal myomectomy for infertility: a comprehensive review. Hum Reprod 13:873–879
Poncelet C, Benifla JL, Batallan A, Daraï E, Madelenat P (2001) Myome et infertilité: analyse de la littérature. Gynecol Obstet Fertil 29:413–421
Campo S, Campo V, Gambadauro P (2003) Reproductive outcome before and after laparoscopic or abdominal myomectomy for subserous or intramural myomas. Eur J Obstet Gynecol Reprod Biol 110:215–219
Casini ML, Rossi F, Agostini R, Unfer V (2006) Effects of the position of fibroids on fertility. Gynecol Endocrinol 22:106–109
Fauconnier A, Dubuisson JB, Ancel PY, Chapron C (2000) Prognostic factors of reproductive outcome after myomectomy in infertile patients. Hum Reprod 15:1751–1757
Sudik R, Hüsch K, Steller J, Daume E (1996) Fertility and pregnancy outcome after myomectomy in sterility patients. Eur J Obstet Gynecol Reprod Biol 65:209–214
Bajekal N, Li TC (2000) Fibroids, infertility and pregnancy wastage. Hum Reprod Update 6:614–620
Donnez J, Jadoul P (2002) What are the implications of myomas on fertility? A need for a debate? Hum Reprod 17:1424–1430
Bendifallah S, Brun J-, Fernandez H (2011) Place de la myomectomie chez une patiente en situation d’infertilité. J Gynecol Obstet Biol Reprod 40:885–901
Paul PG, Koshy AK, Thomas T (2006) Pregnancy outcomes following laparoscopic myomectomy and single-layer myometrial closure. Hum Reprod 21:3278–3281
Seracchioli R, Rossi S, Govoni F, Rossi E, Venturoli S, Bulletti C, Flamigni C (2000) Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Hum Reprod 15:2663–2668
Dubuisson JB, Fauconnier A, Deffarges JV, Norgaard C, Kreiker G, Chapron C (2000) Pregnancy outcome and deliveries following laparoscopic myomectomy. Hum Reprod 15:869–873
Mozurkewich EL, Hutton EK (2000) Elective repeat cesarean delivery versus trial of labor: a meta-analysis of the literature from 1989 to 1999. Obstet Gynecol 183:1187–1197
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Borja de Mozota, D., Kadhel, P. & Janky, E. Fertility, pregnancy outcomes and deliveries following myomectomy: experience of a French Caribbean University Hospital. Arch Gynecol Obstet 289, 681–686 (2014). https://doi.org/10.1007/s00404-013-3038-y
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DOI: https://doi.org/10.1007/s00404-013-3038-y