Abdominal myomectomy in the treatment of infertility

Objective: To determine the effect of abdominal myomectomy as a treatment for infertility in women with uterine leiomyoma. Methods: Records were reviewed for 37 women at Johns Hopkins Hospital who underwent myomectomy as a primary procedure for infertility between 1975 and 1990. Results: Kaplan-Meier life-table analysis demonstrated a cumulative pregnancy rate of 57% and live birth rate of 48%. The size or number of myomas did not affect either the pregnancy rate or the myoma recurrence rate. The presence of pelvic adhesions at the time of myomectomy significantly reduced the chance of conception (P< 0.05). Adhesions were documented in 13 (68%) of 19 patients who underwent abdominal surgery at a later date. Conclusions: Nearly half of the infertile women with uterine leiomyoma were able to bear children following abdominal myomectomy. Adhesion formation appears to be a common occurrence following myomectomy and reduces its effectiveness when present before surgery.