Surgical treatment of fibroids for subfertility

Abstract

Background Fibroids are the most common benign tumours of the female genital tract and are associated with numerous clinical problems including a possible negative impact on fertility. In women requesting preservation of fertility, fibroids can be surgically removed (myomectomy) by laparotomy, laparoscopically or hysteroscopically depending on the size, site and type of fibroid. Myomectomy is however a procedure that is not without risk and can result in serious complications. It is therefore essential to determine whether such a procedure can result in an improvement in fertility and, if so, to then determine the ideal surgical approach. Objectives To examine the e ect of myomectomy on fertility outcomes and to compare di erent surgical approaches. Search methods We searched the Cochrane Gynaecology and Fertility Group (CGFG) Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, Epistemonikos database, World Health Organization (WHO) International Clinical Trials Registry Platform search portal, Database of Abstracts of Reviews of E ects (DARE), LILACS, conference abstracts on the ISI Web of Knowledge, OpenSigle for grey literature from Europe, and reference list of relevant papers. The final search was in February 2019. Selection criteria Randomised controlled trials (RCTs) examining the e ect of myomectomy compared to no intervention or where di erent surgical approaches are compared regarding the e ect on fertility outcomes in a group of infertile women su ering from uterine fibroids. Data collection and analysis Data collection and analysis were conducted in accordance with the procedure suggested in the Cochrane Handbook for Systematic Reviews of Interventions. Main results This review included four RCTs with 442 participants. The evidence was very low-quality with the main limitations being due to serious imprecision, inconsistency and indirectness. Myomectomy versus no intervention Surgical treatment of fibroids for subfertility (Review)

A Five‐Year Retrospective Analysis Comparing Morbidity and Mortality Outcomes of Previous Myomectomy Surgical Delivery, and Elective Repeat Caesarean Section

“…The significant finding of older women in the previous myomectomy group was consistent with the findings by Gimovsky et al [9], and Metwally et al [21], as it is well documented that advanced age is associated with an increased risk of fibroids and infertility. This finding is, therefore, not surprising as older women with fibroids are likely to be of low parity or may have had a myomectomy if symptomatic.…”

A Five‐Year Retrospective Analysis Comparing Morbidity and Mortality Outcomes of Previous Myomectomy Surgical Delivery, and Elective Repeat Caesarean Section

“…The significant finding of older women in the previous myomectomy group was consistent with the findings by Gimovsky et al [9], and Metwally et al [21], as it is well documented that advanced age is associated with an increased risk of fibroids and infertility. This finding is, therefore, not surprising as older women with fibroids are likely to be of low parity or may have had a myomectomy if symptomatic.…”

The effect of myomectomy on reproductive outcomes in patients with uterine fibroids: A retrospective cohort study

“…In accordance with these results, previous studies have demonstrated that a clear effect of myomectomy has not been proven (Bosteels et al, 2018;Brady et al, 2013;Fernandez et al, 2001;Khaw et al, 2020;Klatsky et al, 2008;Metwally et al, 2020;Orlando et al, 2020;Pritts et al, 2009). However, these studies all show that a myomectomy does not decrease fertility rates either and tends to show (non-significant) positive effects of surgical treatment.…”

Hysterolaparoscopy: A Gold Standard for Diagnosing and Treating Infertility and Benign Uterine Pathology

“…The meta-analysis conducted in 2020 by Metwally et al, which included 4 RCTs with 442 infertile patients undergoing laparoscopic/hysteroscopic myomectomy, showed that the evidence is limited and of little statistical relevance [103]. Starting from the conclusion of this study, it is essential to determine the effectiveness of myomectomy in infertility associated with fibroids, and more research is needed to establish on extensive clinical trials how myomectomy can influence the pregnancy rate.…”

A Five‐Year Retrospective Analysis Comparing Morbidity and Mortality Outcomes of Previous Myomectomy Surgical Delivery, and Elective Repeat Caesarean Section

“…The significant finding of older women in the previous myomectomy group was consistent with the findings by Gimovsky et al [9], and Metwally et al [21], as it is well documented that advanced age is associated with an increased risk of fibroids and infertility. This finding is, therefore, not surprising as older women with fibroids are likely to be of low parity or may have had a myomectomy if symptomatic.…”

The effect of myomectomy on reproductive outcomes in patients with uterine fibroids: A retrospective cohort study

“…In accordance with these results, previous studies have demonstrated that a clear effect of myomectomy has not been proven (Bosteels et al, 2018;Brady et al, 2013;Fernandez et al, 2001;Khaw et al, 2020;Klatsky et al, 2008;Metwally et al, 2020;Orlando et al, 2020;Pritts et al, 2009). However, these studies all show that a myomectomy does not decrease fertility rates either and tends to show (non-significant) positive effects of surgical treatment.…”

Hysterolaparoscopy: A Gold Standard for Diagnosing and Treating Infertility and Benign Uterine Pathology

“…The meta-analysis conducted in 2020 by Metwally et al, which included 4 RCTs with 442 infertile patients undergoing laparoscopic/hysteroscopic myomectomy, showed that the evidence is limited and of little statistical relevance [103]. Starting from the conclusion of this study, it is essential to determine the effectiveness of myomectomy in infertility associated with fibroids, and more research is needed to establish on extensive clinical trials how myomectomy can influence the pregnancy rate.…”

A Five‐Year Retrospective Analysis Comparing Morbidity and Mortality Outcomes of Previous Myomectomy Surgical Delivery, and Elective Repeat Caesarean Section

“…The significant finding of older women in the previous myomectomy group was consistent with the findings by Gimovsky et al [9], and Metwally et al [21], as it is well documented that advanced age is associated with an increased risk of fibroids and infertility. This finding is, therefore, not surprising as older women with fibroids are likely to be of low parity or may have had a myomectomy if symptomatic.…”

The effect of myomectomy on reproductive outcomes in patients with uterine fibroids: A retrospective cohort study

“…In accordance with these results, previous studies have demonstrated that a clear effect of myomectomy has not been proven (Bosteels et al, 2018;Brady et al, 2013;Fernandez et al, 2001;Khaw et al, 2020;Klatsky et al, 2008;Metwally et al, 2020;Orlando et al, 2020;Pritts et al, 2009). However, these studies all show that a myomectomy does not decrease fertility rates either and tends to show (non-significant) positive effects of surgical treatment.…”

Hysterolaparoscopy: A Gold Standard for Diagnosing and Treating Infertility and Benign Uterine Pathology

“…The meta-analysis conducted in 2020 by Metwally et al, which included 4 RCTs with 442 infertile patients undergoing laparoscopic/hysteroscopic myomectomy, showed that the evidence is limited and of little statistical relevance [103]. Starting from the conclusion of this study, it is essential to determine the effectiveness of myomectomy in infertility associated with fibroids, and more research is needed to establish on extensive clinical trials how myomectomy can influence the pregnancy rate.…”