Number of Fibroids Removed May Impact Fertility After Myomectomy

Women of reproductive age with symptomatic fibroids who present to Cleveland Clinic are typically offered myomectomy rather than hysterectomy to preserve their fertility. However, myomectomy is associated with potentially extensive blood loss, particularly when multiple fibroids are removed.

Facing a dearth of good data showing that removing fibroids increases a woman’s chance of becoming pregnant, Cleveland Clinic Ob/Gyn researchers undertook a study to evaluate whether the risks of myomectomy would pay off for these women. Under the guidance of Tommaso Falcone, MD, Chairman, Ob/Gyn & Women’s Health Institute, Shirley Shue, a Case Western Reserve University School of Medicine student, examined whether the number of fibroids removed during myomectomy affects long-term fertility outcomes in reproductive-aged women.

“Fibroids are a significant public health issue, especially in the African-American community,” says Dr. Falcone. “So it is very important for us to take on the challenging research this condition requires, and investigate the impact of fibroid surgery.”

The study was presented at the 2107 American Society of Reproductive Medicine (ASRM) Scientific Congress & Expo meeting.

Is six the magic number?

Of 605 patients ages 18-40 who had undergone myomectomy at Cleveland Clinic, 144 responded to a survey. They were categorized as having had one to six fibroids or more than six fibroids removed. Findings included:

• African-American women were more likely than other groups to have more than six fibroids removed (58.3 versus 41.6 percent).
• Patients with more than six fibroids removed were less likely to achieve pregnancy after myomectomy than those with six or fewer fibroids removed (22.9 versus 70.8 percent).
• Compared with 17.6 percent of patients who had six or fewer fibroids removed, 45 percent of those with more than six fibroids removed relied on fertility treatments to achieve pregnancy.
• Of those who became pregnant after having more than six fibroids removed, 45.5 percent had a term birth, 45.5 percent miscarried and 9.1 percent had an ectopic pregnancy. This compares to 61.8, 23.5 and 13.2 percent in women who had six or fewer fibroids removed.

“In the end, we found that women who have more than six fibroids removed may not benefit from myomectomy to the same degree as those with six or fewer fibroids,” says Ms. Shue. “It is unlikely this single study will change clinical practice, but it may open the door to more research.”