Route of myomectomy and fertility: a prospective cohort study

Objective

To assess prospectively the association between the myomectomy route and fertility.

Design

Prospective cohort study.

Setting

The Comparing Treatments Options for Uterine Fibroids (COMPARE-UF) Study is a multisite national registry of eight clinic centers across the United States.

Patient(s)

Reproductive-aged women undergoing surgery for symptomatic uterine fibroids.

Intervention(s)

Not applicable.

Main Outcome Measure(s)

We used life-table methods to estimate cumulative probabilities and 95% confidence intervals (CI) of pregnancy and live birth by the myomectomy route during 12, 24, and 36 months of follow-up (2015–2019). We also conducted 12-month interval-based analyses that used logistic regression to estimate odds ratios and 95% CIs for associations of interest. In all analyses, we used propensity score weighting to adjust for differences across surgical routes.

Result(s)

Among 1,095 women who underwent myomectomy (abdominal = 388, hysteroscopic=273, and laparoscopic=434), 202 reported pregnancy and 91 reported live birth during 36 months of follow-up. There was little difference in the 12-month probability of pregnancy or live birth by route of myomectomy overall or among women intending pregnancy. In interval-based analyses, adjusted ORs for pregnancy were 1.28 (95% CI, 0.76–2.14) for hysteroscopic myomectomy and 1.19 (95% CI, 0.76–1.85) for laparoscopic myomectomy compared with abdominal myomectomy. Among women intending pregnancy, adjusted ORs were 1.27 (95% CI, 0.72–2.23) for hysteroscopic myomectomy and 1.26 (95% CI, 0.77–2.04) for laparoscopic myomectomy compared with abdominal myomectomy. Associations were slightly stronger but less precise for live birth.

Conclusion(s)

The probability of conception or live birth did not differ appreciably by the myomectomy route among women observed for 36 months postoperatively.

Clinical Trials Registration Number

(NCT02260752, clinicaltrials.gov).