skip to main content
Language:
Search Limited to: Search Limited to: Resource type Show Results with: Show Results with: Search type Index

Surgical treatment of fibroids for subfertility

Cochrane database of systematic reviews, 2020-01, Vol.2020 (1), p.CD003857-CD003857 [Peer Reviewed Journal]

Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. ;EISSN: 1465-1858 ;EISSN: 1469-493X ;DOI: 10.1002/14651858.CD003857.pub4 ;PMID: 31995657

Full text available

Citations Cited by
  • Title:
    Surgical treatment of fibroids for subfertility
  • Author: Metwally, Mostafa ; Raybould, Grace ; Cheong, Ying C ; Horne, Andrew W ; Metwally, Mostafa
  • Subjects: Abortion, Spontaneous ; Abortion, Spontaneous - epidemiology ; Cesarean Section ; Cesarean Section - statistics & numerical data ; EVALUATION OF SUBFERTILITY TREATMENTS RELATING TO THE FEMALE PARTNER ; Female ; Female: associated with other medical conditions ; Gynaecology ; Humans ; Infertility, Female ; Infertility, Female - etiology ; Infertility, Female - surgery ; Leiomyomatosis ; Leiomyomatosis - complications ; Leiomyomatosis - surgery ; Live Birth ; Live Birth - epidemiology ; Medicine General & Introductory Medical Sciences ; Pregnancy ; Pregnancy Rate ; Randomized Controlled Trials as Topic ; Subfertility ; SUBFERTILITY ASSOCIATED WITH FIBROIDS ; Surgery ; Uterine Myomectomy ; Uterine Myomectomy - methods ; Uterine Neoplasms ; Uterine Neoplasms - complications ; Uterine Neoplasms - surgery
  • Is Part Of: Cochrane database of systematic reviews, 2020-01, Vol.2020 (1), p.CD003857-CD003857
  • Description: Background Fibroids are the most common benign tumours of the female genital tract and are associated with numerous clinical problems including a possible negative impact on fertility. In women requesting preservation of fertility, fibroids can be surgically removed (myomectomy) by laparotomy, laparoscopically or hysteroscopically depending on the size, site and type of fibroid. Myomectomy is however a procedure that is not without risk and can result in serious complications. It is therefore essential to determine whether such a procedure can result in an improvement in fertility and, if so, to then determine the ideal surgical approach. Objectives To examine the effect of myomectomy on fertility outcomes and to compare different surgical approaches. Search methods We searched the Cochrane Gynaecology and Fertility Group (CGFG) Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, Epistemonikos database, World Health Organization (WHO) International Clinical Trials Registry Platform search portal, Database of s of Reviews of Effects (DARE), LILACS, conference s on the ISI Web of Knowledge, OpenSigle for grey literature from Europe, and reference list of relevant papers. The final search was in February 2019. Selection criteria Randomised controlled trials (RCTs) examining the effect of myomectomy compared to no intervention or where different surgical approaches are compared regarding the effect on fertility outcomes in a group of infertile women suffering from uterine fibroids. Data collection and analysis Data collection and analysis were conducted in accordance with the procedure suggested in the Cochrane Handbook for Systematic Reviews of Interventions. Main results This review included four RCTs with 442 participants. The evidence was very low‐quality with the main limitations being due to serious imprecision, inconsistency and indirectness. Myomectomy versus no intervention One study examined the effect of myomectomy compared to no intervention on reproductive outcomes. We are uncertain whether myomectomy improves clinical pregnancy rate for intramural (odds ratio (OR) 1.88, 95% confidence interval (CI) 0.57 to 6.14; 45 participants; one study; very low‐quality evidence), submucous (OR 2.04, 95% CI 0.62 to 6.66; 52 participants; one study; very low‐quality evidence), intramural/subserous (OR 2.00, 95% CI 0.40 to 10.09; 31 participants; one study; very low‐quality evidence) or intramural/submucous fibroids (OR 3.24, 95% CI 0.72 to 14.57; 42 participants; one study; very low‐quality evidence). Similarly, we are uncertain whether myomectomy reduces miscarriage rate for intramural fibroids (OR 1.33, 95% CI 0.26 to 6.78; 45 participants; one study; very low‐quality evidence), submucous fibroids (OR 1.27, 95% CI 0.27 to 5.97; 52 participants; one study; very low‐quality evidence), intramural/subserous fibroids (OR 0.80, 95% CI 0.10 to 6.54; 31 participants; one study; very low‐quality evidence) or intramural/submucous fibroids (OR 2.00, 95% CI 0.32 to 12.33; 42 participants; one study; very low‐quality evidence). This study did not report on live birth, preterm delivery, ongoing pregnancy or caesarean section rate. Laparoscopic myomectomy versus myomectomy by laparotomy or mini‐laparotomy Two studies compared laparoscopic myomectomy to myomectomy at laparotomy or mini‐laparotomy. We are uncertain whether laparoscopic myomectomy compared to laparotomy or mini‐laparotomy improves live birth rate (OR 0.80, 95% CI 0.42 to 1.50; 177 participants; two studies; I2 = 0%; very low‐quality evidence), preterm delivery rate (OR 0.70, 95% CI 0.11 to 4.29; participants = 177; two studies; I2 = 0%, very low‐quality evidence), clinical pregnancy rate (OR 0.96, 95% CI 0.52 to 1.78; 177 participants; two studies; I2 = 0%, very low‐quality evidence), ongoing pregnancy rate (OR 1.61, 95% CI 0.26 to 10.04; 115 participants; one study; very low‐quality evidence), miscarriage rate (OR 1.25, 95% CI 0.40 to 3.89; participants = 177; two studies; I2 = 0%, very low‐quality evidence), or caesarean section rate (OR 0.69, 95% CI 0.34 to 1.39; participants = 177; two studies; I2 = 21%, very low‐quality evidence). Monopolar resectoscope versus bipolar resectoscope One study evaluated the use of two electrosurgical systems during hysteroscopic myomectomy. We are uncertain whether bipolar resectoscope use compared to monopolar resectoscope use improves live birth/ongoing pregnancy rate (OR 0.86, 95% CI 0.30 to 2.50; 68 participants; one study, very low‐quality evidence), clinical pregnancy rate (OR 0.88, 95% CI 0.33 to 2.36; 68 participants; one study; very low‐quality evidence), or miscarriage rate (OR 1.00, 95% CI 0.19 to 5.34; participants = 68; one study; very low‐quality evidence). This study did not report on preterm delivery or caesarean section rate. Authors' conclusions There is limited evidence to determine the role of myomectomy for infertility in women with fibroids as only one trial compared myomectomy with no myomectomy. If the decision is made to have a myomectomy, the current evidence does not indicate a superior method (laparoscopy, laparotomy or different electrosurgical systems) to improve rates of live birth, preterm delivery, clinical pregnancy, ongoing pregnancy, miscarriage, or caesarean section. Furthermore, the existing evidence needs to be viewed with caution due to the small number of events, minimal number of studies and very low‐quality evidence.
  • Publisher: Chichester, UK: John Wiley & Sons, Ltd
  • Language: English
  • Identifier: EISSN: 1465-1858
    EISSN: 1469-493X
    DOI: 10.1002/14651858.CD003857.pub4
    PMID: 31995657
  • Source: MEDLINE
    Alma/SFX Local Collection
    Cochrane Library (Open Aceess)
Back to results list
INSPIRE LIBRARY - TON DUC THANG UNIVERSITY (84-028) 37 755 057 Feedback
19 Nguyen Huu Tho St. Dist.7, HCM thuvien@tdtu.edu.vn

Copyright © 2017 INSPIRE LIBRARY - TON DUC THANG UNIVERSITY

Searching Remote Databases, Please Wait