The impact of hysteroscopic myomectomy on fertility and pregnancy outcomes of infertile women according characteristics of submucous fibroids

Abstract

The impact of hysteroscopic myomectomy on fertility and pregnancy outcomes of infertile women according characteristics of submucous fibroids I. Rudic Biljic-Erski, M. Vasiljevic, S. Rakic, S. Mihajlovic, O. D. Smiljkovic Clinic of Gynecology and Obstetrics “Narodni Front”, Belgrade; Medical Faculty University of Belgrade, Belgrade (Serbi) Summary Purpose of investigation: To assess fertility and pregnancy outcomes in infertile patients after hysteroscopic myomectomy according characteristics of submucous fibroids. Materials and Methods: The authors included 56 infertile women, who were diagnosed with a submucous uterine fibroid, and assessed their fertility and pregnancy outcomes after hysteroscopic myomectomy, which was the exposure of interest. The control group consisted of 63 women who underwent a hysteroscopic polypectomy. The submucous fibroid and endometrial polyp were diagnosed preoperatively using 2D ultrasound, and the diagnosis was confirmed during hysteroscopy. All myomectomies and polypectomies were performed using a resectoscope with a bipolar loop electrode. In the first postoperative year, the authors analyzed the rates of pregnancy, spontaneous abortion, preterm and term deliveries, as well as mode of delivery according to type, size, location, and number of submucous fibroids or polyps in each group. Results: In the first postoperative year, pregnancy occurred in 30.4% of patients. The greatest proportion of pregnancies occurred after removal of type 1 submucous fibroids, fibroids < 3 cm, and those localized on the posterior wall of the uterine corpus. Spontaneous abortion occurred in 7.1% of pregnancies, while delivery occurred in 19.6%. Term delivery occurred in 16.1%, while preterm delivery occurred in 3.6%. Vaginal delivery occurred in 14.3% of women, while caesarean section was performed in 5.4% of women. There were not significant differences in rates of pregnancy and delivery according to type, size, and localization of the fibroid or endometrial polyp. Conclusion: For infertile patients, in whom infertility is caused by a submucous fibroid, hysteroscopic myomectomy increases the pregnancy rate, and leads to good reproductive outcomes. Key words: Hysteroscopy; Fibroid; Myomectomy; Pregnancy; Infertility.