Surgical and reproductive outcomes after myomectomy: a retrospective cohort study of open and minimally invasive approaches in a UK tertiary centre

Uterine fibroids are common benign tumours contributing to infertility in approximately 3% of women. Submucosal and deep intramural fibroids can distort the uterine cavity, impairing implantation and live birth rates. Myomectomy, performed through laparotomy or minimally invasive approaches, is the surgical removal of fibroids when fertility preservation is desired. However, there is limited evidence for myomectomy improving fertility outcomes, regardless of the surgical approach. This study aimed to examine different surgical approaches in myomectomy and their associations with post-operative, fertility and pregnancy outcomes. This retrospective single-centre cohort study of all myomectomies was undertaken at the Sheffield Teaching Hospitals between 2017 and 2019. Electronic records, investigations and operation notes were reviewed. Primary outcomes included clinical pregnancy after myomectomy. Secondary outcomes included live birth, post-operative complications and length of stay. 23 out of 71 cases (32%) had a myomectomy due to subfertility. 14 cases (61%) had primary infertility. Following myomectomy, 13 out of 23 women (56.5%; 95% proportion CI 36.5–75.0%) with subfertility achieved a clinical pregnancy. Eleven cases (11/23, 95% proportion CI 28.7–67.5%) resulted in a live birth. As this cohort lacked a non-surgical comparison group, these represent observational post-operative outcomes. There was no significant association between open and minimally invasive approaches and chance of pregnancy ( p = 0.339). There was no association between post-operative outcomes and surgical approach ( p > 0.05). There was a significant difference in length of stay between surgical approaches ( p < 0.01) with minimally invasive surgery (median 2 days, range 0–4 days) having significantly shorter stays than open approach (median 3 days, range 1–8 days). In this cohort, a proportion of women achieved clinical pregnancies and live births post-myomectomy. Laparoscopic and open myomectomy had similar post-operative outcomes, but minimally invasive approaches showed reduced lengths of stay. Interpretation is limited by the retrospective design, small sample size and absence of a non-surgical comparison group. Further research is required to assess the relationship between myomectomy, surgical approach and reproductive outcomes.