Removal of FIGO V And VI Fibroids with a Combined Size Greater than 5 cm Quadruples Spontaneous Fecundity Relative to Myomectomy for Those with Smaller Fibroids

Abstract Purpose:Fibroids are the most common gynecological pathology in reproductive aged women and contribute to 2-3% of infertility cases. After hysteroscopic removal of submucosal FIGO 0 and I fibroids, pregnancy rates of 60% to 90% can be achieved. Pregnancy rates after non-hysteroscopic removal of subserosal FIGO V and VI fibroids remain controversial. Methods: We examined all myomectomies per laparoscopy/laparotomy for FIGO V and VI fibroids performed at the Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, from 2012 to 2021. All women with primary and secondary infertility between the ages of 18 and 40 years with 1-3 subserous fibroids without additionally identified causes for infertility were included. The outcome was the clinical pregnancy rate within 12 months after a postoperative nonconception window. A logistic regression model was used to assess associations between patient characteristics and postoperative pregnancy rates. The association was estimated as odds ratio (OR) with the respective 95% confidence interval (CI). Results: We included a total of 80 women with a median age of 34.5 years (IQR, 31.4-37.8). Of those, 42 patients (52.5%) had primary infertility and 38 patients (47.5%) had secondary infertility. Fibroid size ranged from 2 cm to 30 cm with a median size of 7.5 cm. Pregnancy occurred in 36 patients (45.0%) at a median of 4 months (IQR 3.0-7.0) after an initial postoperative 6 months, where pregnancy was permitted. Age (OR 0.77, 95% CI 0.67-0.88) and fibroid size (OR 1.25; 95% CI 1.072-1.446) were significantly associated with the occurrence of a clinical pregnancy. Conclusion: In this cohort of infertile women of reproductive age with FIGO V and VI fibroids, almost half became spontaneously pregnant within 12 months after a postoperative non-conception window of myomectomy per laparoscopy/laparotomy. Patients with larger fibroids were more likely to conceive after myomectomy.