Recovery of reproductive function after myomectomy in women with uterine fibroids and infertility

• Mark F. Dorfman
• Aleksandr S. Gasparov
• Eketerina D. Dubinskaya
• Roman E. Orekhov
• Suren L. Vartanyan
• Evgeniia V. Gubanova
• Mariam G. Sahakyan
• Sofia F. Dorfman

Abstract

The aim of the study was to determine the significance of a variety of modeling and surgical navigation technologies in the preservation and recovery of reproductive function in the treatment of cellular uterine fibroids in women with infertility.

Material and methods. The study presents the results of a comprehensive examination and treatment of 100 patients with cellular uterine myoma (UM), with type 3–6 nodes according to the FIGO (International Federation Gynecology and Obstetrics) classification, with a minimum size of the leading node of >4 cm and infertility. All patients underwent surgical treatment in the amount of myomectomy by laparoscopic access. The main group included 50 patients with UM, who underwent the construction of a 3D-model of the uterus with nodes and features of their topography. Myomectomy was performed using the author’s technology of surgical navigation. The comparison group included 50 patients with UM who underwent preoperative examination and surgery according to standard clinical protocols. The analysis of ovarian reserve indicators before and 6 months after surgery was performed: determination of anti-mullerian, follicle-stimulating hormones; counting the number of antral follicles and measuring vascularization and blood flow indices. An assessment was made of the frequency of pregnancy in the natural cycle 2 years after myomectomy.

When assessing the dynamics of ovarian reserve markers, their decrease was revealed both in the main and in the comparison group. At the same time, the decrease in ovarian reserve in women in the comparison group was significantly higher compared to the main group. Analysis of the frequency of pregnancy in the natural cycle 2 years after myomectomy also shows significantly high rates: pregnancy occurred spontaneously in 24 (48%) patients of the main group and in 14 (28%) patients in the comparison group (p=0.0378).

Conclusion. An innovative myomectomy technique using 3D-modeling and endoscopic navigation during surgical intervention in patients with cellular UM and infertility significantly reduces the ovarian reserve to a lesser extent and increases the probability of pregnancy in the natural cycle by 1.7 times.

Keywords:operative 3D-modeling; surgical navigation; myomectomy; ovarian reserve; fast-track; cellular fibroids; proliferative fibroids

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