TY - JOUR
T1 - The effect of myomectomy on reproductive outcomes in patients with uterine fibroids
T2 - A retrospective cohort study
AU - Don, Emma E.
AU - Mijatovic, Velja
AU - van Eekelen, Rik
AU - Huirne, Judith A. F.
N1 - Funding Information: Declaration: Although the authors report no financial or commercial conflicts of interest relating this paper, they would like to declare the following: V.M. has received research grants from Merck, Ferring, IQ Medical and Guerbet for other projects regarding (in)fertility and endometriosis. J.A.F.H. is currently performing a randomized controlled trial that is comparing ulipristal in long–term intermittent treatment with standard surgery (hysterectomy, myomectomy and uterine artery embolization): the MYOMEX–2 trial. This is a principle investigator-initiated study, funded by NWO–ZonMW. J.A.F.H. has also received one investigator-initiated research grant from Samsung for the use of 3D power Doppler scanning in the evaluation of fibroids, and has received a research grant from NWO-TTW on contrast-enhanced ultrasonography in gynaecology. Finally, J.A.F.H. has received expenses for lectures on fibroid diagnostic methods and non-invasive therapies from Samsung Medison and Olympus. Funding Information: The authors thank Claire H. Laeven and Guus Vissers for their help in contacting patients and data-entry work in Castor during their scientific internships. Declaration: Although the authors report no financial or commercial conflicts of interest relating this paper, they would like to declare the following: V.M. has received research grants from Merck, Ferring, IQ Medical and Guerbet for other projects regarding (in)fertility and endometriosis. J.A.F.H. is currently performing a randomized controlled trial that is comparing ulipristal in long–term intermittent treatment with standard surgery (hysterectomy, myomectomy and uterine artery embolization): the MYOMEX–2 trial. This is a principle investigator-initiated study, funded by NWO–ZonMW. J.A.F.H. has also received one investigator-initiated research grant from Samsung for the use of 3D power Doppler scanning in the evaluation of fibroids, and has received a research grant from NWO-TTW on contrast-enhanced ultrasonography in gynaecology. Finally, J.A.F.H. has received expenses for lectures on fibroid diagnostic methods and non-invasive therapies from Samsung Medison and Olympus. Publisher Copyright: © 2022 The Author(s)
PY - 2022/11
Y1 - 2022/11
N2 - Research question: What is the effect of myomectomy in women with uterine fibroids on time to live birth and other reproductive outcomes? Design: This was a monocentric retrospective cohort study of 311 women with fibroids, of whom 165 eventually received myomectomy and 146 remained on expectant management. To assess the primary outcome time to live birth, a Cox proportional hazards model with a time-varying covariate for myomectomy was used. In the sensitivity analyses, this was combined with an approach to account for confounders via a cloning/censoring/weighting that aimed to emulate a randomized controlled trial. Results: Notable differences in baseline characteristics between the myomectomy and expectant management group were fibroid size (fibroid >7 cm: myomectomy 48%; expectant management 15%) and whether the patient had fibroid-related complaints (myomectomy 85%, expectant management 67%). The adjusted hazard ratio for the effect of myomectomy compared with expectant management on live birth was 1.26 (95% CI 0.87–1.81). Sensitivity analyses yielded similar results, but secondary outcomes showed that women remaining on expectant management had more often received assisted reproductive technology (63%) compared with those who eventually received myomectomy (38%). Conclusions: The study did not find a significant difference in time to live birth after myomectomy compared with expectant management in women with fibroids and a wish to conceive, despite more, larger and more symptomatic fibroids in the myomectomy group. The results after myomectomy encourage the execution of a randomized controlled trial in women with large (symptomatic) fibroids not or minimally distorting the intrauterine cavity, and infertility or a desire to conceive.
AB - Research question: What is the effect of myomectomy in women with uterine fibroids on time to live birth and other reproductive outcomes? Design: This was a monocentric retrospective cohort study of 311 women with fibroids, of whom 165 eventually received myomectomy and 146 remained on expectant management. To assess the primary outcome time to live birth, a Cox proportional hazards model with a time-varying covariate for myomectomy was used. In the sensitivity analyses, this was combined with an approach to account for confounders via a cloning/censoring/weighting that aimed to emulate a randomized controlled trial. Results: Notable differences in baseline characteristics between the myomectomy and expectant management group were fibroid size (fibroid >7 cm: myomectomy 48%; expectant management 15%) and whether the patient had fibroid-related complaints (myomectomy 85%, expectant management 67%). The adjusted hazard ratio for the effect of myomectomy compared with expectant management on live birth was 1.26 (95% CI 0.87–1.81). Sensitivity analyses yielded similar results, but secondary outcomes showed that women remaining on expectant management had more often received assisted reproductive technology (63%) compared with those who eventually received myomectomy (38%). Conclusions: The study did not find a significant difference in time to live birth after myomectomy compared with expectant management in women with fibroids and a wish to conceive, despite more, larger and more symptomatic fibroids in the myomectomy group. The results after myomectomy encourage the execution of a randomized controlled trial in women with large (symptomatic) fibroids not or minimally distorting the intrauterine cavity, and infertility or a desire to conceive.
KW - Infertility
KW - Live birth
KW - Myomectomy
KW - Uterine fibroid
UR - http://www.scopus.com/inward/record.url?scp=85136677880&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.rbmo.2022.05.025
DO - https://doi.org/10.1016/j.rbmo.2022.05.025
M3 - Article
C2 - 36041962
SN - 1472-6483
VL - 45
SP - 970
EP - 978
JO - Reproductive BioMedicine Online
JF - Reproductive BioMedicine Online
IS - 5
ER -