Pregnancy outcomes following hysteroscopic myomectomy in infertile patients with FIGO type 0-II fibroids: a retrospective study

Abstract

Background We aimed to evaluate the feasibility and safety of hysteroscopic myomectomy (HM) in infertile patients with International Federation of Gynecology and Obstetrics (FIGO) Type 0, I, and II uterine fibroids.Methods This study included infertile patients with FIGO type 0, I, and II uterine fibroids who underwent HM before embryo transfer. After surgery, an intrauterine device (IUD) was placed in the uterine cavity, and an adhesion barrier gel was applied. Two months later, the IUD was removed and a control hysterosalpingography (HSG) was performed. Embryo transfer was carried out in patients without suspected intrauterine adhesions (IUA) on HSG. The primary outcomes were clinical pregnancy and live birth rates, and the secondary outcomes were the complication rate and the incidence of IUA.Results Fifty patients were included. Overall, 39 (78%) conceived, and 21 (42%) achieved a live birth. Second-look hysteroscopy was performed in 4 (8%) patients due to suspected IUA. All four patients subsequently conceived; two had a live birth and two had a biochemical pregnancy. Three patients underwent repeat HM because of new myoma formation. After the second HM, HSG showed no IUA in one patient; embryo transfer was performed, but pregnancy was not achieved. In another patient, IUA were detected; hysteroscopic adhesiolysis was performed, and subsequent evaluation showed no IUA, yet pregnancy was not achieved after embryo transfer. In the third patient, a submucosal myoma was detected and a third HM was performed; follow-up HSG showed no IUA, and embryo transfer resulted in a biochemical pregnancy. Overall, 6 (12%) patients developed IUA. No cases of massive bleeding, uterine perforation, or fluid overload were observed.Conclusion HM appears to be a safe and reliable method in the treatment of FIGO type 0, I, and II myomas and may improve the pregnancy outcomes when performed before embryo transfer.