The Fibroid Removal in Sterility Treatment ‘‘FIRST’’ Survey: A European Society of Gynecology Online Questionnaire

Background: /Objectives: Clinical management of uterine fibroids in the context of infertility is characterised by significant heterogeneity. The aim of our study was to record the participants’ views and clinical practices regarding minimally invasive, fertility-sparing management of fibroids, focusing on fertility outcomes. Methods: Online survey distributed to members of the European Society of Gynecology (ESG), using a questionnaire comprising 27 questions. Questions 1 to 5 related to the participants’ background, while questions 6 to 27 related to the clinical management of fibroids. Results: 98 participants completed the survey, 83% (n=82) of which practice in European countries. 43% (n=42) had completed specialist training in minimally invasive gynecological surgery. For FIGO 0–II fibroids, 94% of participants recommended hysteroscopic removal in infertile patients. 50% may use anti-adhesion agents after hysteroscopic removal of FIGO 0–II fibroids. For FIGO III fibroids, 57% of participants (n=56) believe they have a detrimental impact on fertility while, for FIGO IV fibroids, 51% (n=50) believe the same. 48% of participants (n=49) stated that the distance between the inner portion of an intramural, non-cavity distorting fibroid and the junctional zone does not affect their decision for removal in infertile patients, and 51% (n=50) stated that it does, with variable cut-off values given. The majority of participants favour minimal access approaches over traditional laparotomy; however, the use of robot-assisted laparoscopy was limited. Conclusions: Our results confirm the significant variation in clinical practice associated with fibroid management and underline the need for standardised care, based on high-quality evidence.