Fertility and Symptom Relief following Robot-Assisted Laparoscopic Myomectomy
OBJECTIVE To describe fecundity after robot-assisted laparoscopic myomectomy for deep intramural myomas. DESIGN Prospective observational study. SETTING University hospital. POPULATION Women undergoing robot-assisted laparoscopic myomectomy. METHODS Expanding on a previous prospective feasibility study, 31 consecutive women in whom a robot-assisted laparoscopic myomectomy was performed between April 2006 and July 2010 were included. The women, of whom 14 had known infertility, were selected for having symptomatic, deep intramural myomas with a possible impact on fertility. Using a prospective protocol, relevant peri-operative and follow-up data were retrieved. MAIN OUTCOME MEASURES Fertility and pregnancy outcome. RESULTS The 31 women included had a median age of 35 years (range 28-42 years) and median body mass index of 22.0 kg/m(2) (range 20.1-24.7 kg/m(2) ). Fifteen (68%) of the 22 women with an active wish of conceiving had become pregnant at a median time of 10 months after surgery. A total of 18 pregnancies occurred, resulting in three miscarriages, two terminated pregnancies, 10 successful term deliveries and three ongoing pregnancies. The subgroup of 14 women with a known but otherwise unexplained infertility had a similar pregnancy rate (69%) and of those, 55% conceived naturally. The women who conceived naturally were on average eight years younger than the women becoming pregnant after in vitro fertilization, and all miscarriages occurred in an in vitro fertilization pregnancy. CONCLUSIONS In women with symptomatic, deep intramural myomas and either otherwise unexplained infertility or myomas with a possible effect on conception, the pregnancy rate following robot-assisted laparoscopic myomectomy was 68%.