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Predictors of reproductive outcomes following myomectomy for intramural fibroids.
Lebovitz, Oshrit; Orvieto, Raoul; James, Kaitlyn E; Styer, Aaron K; Brown, Douglas N.
Afiliação
  • Lebovitz O; Vincent Department of Obstetrics and Gynecology, Reproductive Medicine and IVF, Massachusetts General Hospital, Boston MA, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston MA, USA. Electronic address: lebovitzo@gmail.com.
  • Orvieto R; Infertility and In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel-Hashomer) and The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel Aviv, Israel.
  • James KE; The Deborah Kelly Center for Outcomes Research, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston MA, USA.
  • Styer AK; Department of Obstetrics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston MA, USA; Colorado Center for Reproductive Medicine-Boston, Chestnut-Hill MA, USA.
  • Brown DN; Vincent Department of Obstetrics and Gynecology, Reproductive Medicine and IVF, Massachusetts General Hospital, Boston MA, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston MA, USA.
Reprod Biomed Online ; 39(3): 484-491, 2019 Sep.
Article em En | MEDLINE | ID: mdl-31378690
RESEARCH QUESTION: Which factors are associated with reproductive outcomes among infertile women undergoing myomectomy for intramural fibroids? DESIGN: This was a historical cohort study including 127 infertile women who underwent myomectomy due to intramural fibroids as part of fertility enhancement treatment at a single academic tertiary-care medical centre between the years 2011 and 2015. Demographic characteristics, pre-operative evaluation, surgical factors and post-surgical factors were compared between women who successfully conceived and those who did not following myomectomy. RESULTS: The overall clinical pregnancy rate following myomectomy was 58.3% (n = 74). Women with successful conception were significantly younger (35.4 ± 4.5 years versus 37.2 ± 4.0 years; P = 0.022), and mostly white (63.5% versus 24.3% African-American; P = 0.008). In addition, patients who conceived had larger fibroids demonstrated in pre-operative imaging and during surgery (7.3 versus 6.1 cm and 7.8 versus 6.6 cm; P = 0.003 and 0.022, respectively), with fewer cases of cavity entry determined during surgery (9.5% versus 28.3%; P = 0.005). Multivariable modified Poisson regression models identified the patient's age (risk ratio [RR] 0.96, 95% confidence interval [CI] 0.93-0.99; P =0.014) and race (RR for African-American women versus white women 0.58, 95% CI 0.38-0.88; P = 0.011) as factors significantly associated with the probability of conceiving following myomectomy. CONCLUSION(S): Age and race play a significant role in the reproductive outcomes of infertile women undergoing intramural fibroid myomectomy as part of fertility enhancement treatment. Further large prospective studies are needed to identify specific factors associated with achieving pregnancy, which will help to determine the clinical management of infertile women with intramural fibroids.
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Texto completo: 1 Bases de dados: MEDLINE Assunto principal: Taxa de Gravidez / Miomectomia Uterina / Infertilidade Feminina / Leiomioma Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Pregnancy Idioma: En Revista: Reprod Biomed Online Assunto da revista: MEDICINA REPRODUTIVA Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Bases de dados: MEDLINE Assunto principal: Taxa de Gravidez / Miomectomia Uterina / Infertilidade Feminina / Leiomioma Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Pregnancy Idioma: En Revista: Reprod Biomed Online Assunto da revista: MEDICINA REPRODUTIVA Ano de publicação: 2019 Tipo de documento: Article