Determinants of pregnancy rate and obstetric outcome after laparoscopic myomectomy for infertility

Objective: To determine the effect of myomectomy on infertility and to assess the factors influencing reproductive outcome. Design: Retrospective study. Setting: Tertiary care center. Patient(s): One hundred and three infertile women with uterine leiomyoma who had had infertility >2 years and a follow-up time > 12 months were enrolled. Follow-up was complete for 88 patients, including 28 (31.8%) with primary infertility and 44 (50%) with unexplained infertility. The mean (+/- SD) age of the patients was 36.1 +/- 2.1 years. Intervention(s): Laparoscopic myomectomy. Main Outcome Measure(s): Pregnancy rate according to patient and fibroid characteristics. Result(s): Forty-two patients became pregnant (40.7%). The mean (+/- SD) delay in conception was 7.5 +/- 2.6 months. Nearly 80% of the women conceived spontaneously. Of 44 pregnancies in 42 women, 36 live newborns were delivered. No dehiscence of uterine sear occurred. The pregnancy rate was significantly higher in women < 35 years of age or <3 years of infertility. Women with unexplained infertility had higher pregnancy rate than did women with multifactorial infertility (P < .001). No difference was noted in pregnancy rates according to fibroid characteristics. Conclusion(s): Fertility and pregnancy after laparoscopic myomectomy depend primarily on patient age, duration of infertility before myomectomy, and existence of associated infertility factors. (C) 2001 by American Society for Reproductive Medicine.