Boegl Magdalena, Ott Johannes, Seidl Elena, Goldstein Tal, Parry John Preston, Hager Marlene
Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
Positive Steps Fertility, Madison, MS, USA.
Arch Gynecol Obstet. 2025 May 23. doi: 10.1007/s00404-025-08063-x.
Fibroids are the most common gynecological pathology in reproductive aged women and contribute to 2-3% of infertility cases. After hysteroscopic removal of submucosal FIGO 0 and I fibroids, pregnancy rates of 60% to 90% can be achieved. Pregnancy rates after non-hysteroscopic removal of subserosal FIGO V and VI fibroids remain controversial.
We examined all myomectomies per laparoscopy/laparotomy for FIGO V and VI fibroids performed at the Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, from 2012 to 2021. All women with primary and secondary infertility between the ages of 18 and 40 years with 1-3 subserous fibroids without additionally identified causes for infertility were included. The outcome was the clinical pregnancy rate within 12 months after a postoperative non-conception window. A logistic regression model was used to assess associations between patient characteristics and postoperative pregnancy rates. The association was estimated as odds ratio (OR) with the respective 95% confidence interval (CI).
We included a total of 80 women with a median age of 34.5 years (IQR, 31.4-37.8). Of those, 42 patients (52.5%) had primary infertility and 38 patients (47.5%) had secondary infertility. Fibroid size ranged from 2 to 30 cm with a median size of 7.5 cm. Pregnancy occurred in 36 patients (45.0%) at a median of 4 months (IQR 3.0-7.0) after initial postoperative 6 months, where pregnancy was permitted. Age (OR 0.77, 95% CI 0.67-0.88) and fibroid size (OR 1.25; 95% CI 1.072-1.446) were significantly associated with the occurrence of a clinical pregnancy.
In this cohort of infertile women of reproductive age with FIGO V and VI fibroids, almost half became spontaneously pregnant within 12 months after a postoperative non-conception window of myomectomy per laparoscopy/laparotomy. Patients with larger fibroids were more likely to conceive after myomectomy.
子宫肌瘤是育龄期女性最常见的妇科疾病，在不孕症病例中占2%-3%。宫腔镜下切除黏膜下FIGO 0级和I级子宫肌瘤后，妊娠率可达60%至90%。非宫腔镜下切除浆膜下FIGO V级和VI级子宫肌瘤后的妊娠率仍存在争议。
我们检查了2012年至2021年在维也纳医科大学妇科内分泌与生殖医学临床科通过腹腔镜/剖腹手术对FIGO V级和VI级子宫肌瘤进行的所有肌瘤切除术。纳入所有年龄在18至40岁之间、患有1-3个浆膜下肌瘤且未发现其他不孕原因的原发性和继发性不孕女性。结果指标为术后非受孕窗口期12个月内的临床妊娠率。采用逻辑回归模型评估患者特征与术后妊娠率之间的关联。关联度以优势比（OR）及相应的95%置信区间（CI）表示。
我们共纳入80名女性，中位年龄为34.5岁（四分位间距，31.4-37.8）。其中，42例患者（52.5%）为原发性不孕，38例患者（47.5%）为继发性不孕。肌瘤大小在2至30厘米之间，中位大小为7.5厘米。36例患者（45.0%）在术后最初6个月允许妊娠后的中位4个月（四分位间距3.0-7.0）怀孕。年龄（OR 0.77，95% CI 0.67-0.88）和肌瘤大小（OR 1.25；95% CI 1.072-1.446）与临床妊娠的发生显著相关。
在这组患有FIGO V级和VI级子宫肌瘤的育龄期不孕女性中，几乎一半在腹腔镜/剖腹手术切除肌瘤后的术后非受孕窗口期12个月内自然受孕。肌瘤较大的患者在肌瘤切除术后更易受孕。
