Submucous myomas and their implications in the pregnancy rates of patients with otherwise unexplained primary infertility undergoing hysteroscopic myomectomy: a randomized matched control study.

OBJECTIVE

To determine whether hysteroscopic myomectomy for submucous fibroids in women with unexplained primary infertility achieved better pregnancy rates than no intervention.

DESIGN

Prospective randomized matched control trial.

SETTING

Tertiary university fertility care unit.

PATIENT(S): From January 1999 to February 2006, a total of 215 women with unexplained primary infertility and with ultrasonographically diagnosed submucous myomas as the sole cause for fertility failure were recruited.

INTERVENTION(S): Women were randomly allocated to one of two pretreatment groups matched by age. Hysteroscopic myomectomy was performed in the study group (n = 101). Diagnostic hysteroscopy and myoma biopsy was performed in the control group (n = 103). No fertility therapy was given for either group.

MAIN OUTCOME MEASURE(S): Clinical pregnancy rates according to patient and myoma characteristics.

RESULT(S): The baseline characteristics of both patients and submucous myomas were comparable. Among patients with complete follow-up, a total of 93 (45.6%) pregnancies occured-64 (63.4%) in the study group and 29 (28.2%) in the control group. Women in the study group had a better possibility of becoming pregnant after hysteroscopic myomectomy with a relative risk of 2.1 (95% confidence interval, 1.5-2.9). No difference in pregnancy rates was observed according to size, number, and location of myomas in both groups. However, fertility rates appeared to increase after hysteroscopic myomectomy of type 0 and type I myomas (P < 0.05). In contrast, for the subgroup of patients with type II myomas, no difference in fertility rates were noted.

CONCLUSION(S): Hysteroscopic myomectomy for submucous fibroids in women with unexplained primary infertility is effective in achieving a better pregnancy rate. We think that a multicenter study should be conducted before evaluating the impact of submucous myoma characteristics on fertility outcome.