Laparoscopic myomectomy in infertile women
Epublication WebSurg.com, Feb 2015;15(02). URL: http://websurg.com/doi/lt03engordts005
The incidence of fibroids in women of reproductive age is reported to be between 20 and 40% (Verkauf, 1992; American Society for Reproductive Medicine, 2001). Their presence could cause failure to conceive, but no scientific evidence supports improvement after the surgical removal of the fibroid. This was recently highlighted in a review (Donnez and Jadoul, 2002) reporting a pregnancy rate after myomectomy in infertile women varying between 10 and 80%. Reported results in the literature are confusing due to the heterogeneity of the included patients and the different final outcomes. While subserosal and submucosal leiomyomas are likely to originate respectively from the outer myometrium and junctional zone myometrium, intramural fibroids may originate from the outer myometrium as well as from the junctional zone of the myometrium. It is agreed, although not proven, that patients with submucosal and intramural myomas have an impaired reproductive performance. Removal of submucosal myoma will result in a better reproductive performance, which is not obvious after removal of intramural myoma. Laparoscopic removal has the benefit to have a lower morbidity and a lower risk for postoperative adhesion formation. Benefits and techniques will be discussed.