Route of myomectomy and fertility: a prospective cohort study

Objective: To assess prospectively the association between the myomectomy route and fertility. Design: Prospective cohort study. Setting: The Comparing Treatments Options for Uterine Fibroids (COMPARE-UF) Study is a multisite national registry of eight clinic centers across the United States. Patient(s): Reproductive-aged women undergoing surgery for symptomatic uterine fibroids. Intervention(s): Not applicable. Main Outcome Measure(s): We used life-table methods to estimate cumulative probabilities and 95% confidence intervals (CI) of pregnancy and live birth by the myomectomy route during 12, 24, and 36 months of follow-up (2015–2019). We also conducted 12-month interval-based analyses that used logistic regression to estimate odds ratios and 95% CIs for associations of interest. In all analyses, we used propensity score weighting to adjust for differences across surgical routes. Result(s): Among 1,095 women who underwent myomectomy (abdominal = 388, hysteroscopic = 273, and laparoscopic = 434), 202 reported pregnancy and 91 reported live birth during 36 months of follow-up. There was little difference in the 12-month probability of pregnancy or live birth by route of myomectomy overall or among women intending pregnancy. In interval-based analyses, adjusted ORs for pregnancy were 1.28 (95% CI, 0.76–2.14) for hysteroscopic myomectomy and 1.19 (95% CI, 0.76–1.85) for laparoscopic myomectomy compared with abdominal myomectomy. Among women intending pregnancy, adjusted ORs were 1.27 (95% CI, 0.72–2.23) for hysteroscopic myomectomy and 1.26 (95% CI, 0.77–2.04) for laparoscopic myomectomy compared with abdominal myomectomy. Associations were slightly stronger but less precise for live birth. Conclusion(s): The probability of conception or live birth did not differ appreciably by the myomectomy route among women observed for 36 months postoperatively. Clinical Trials Registration Number: (NCT02260752, clinicaltrials.gov).