A multicenter randomized, controlled study comparing laparoscopic versus minilaparotomic myomectomy: reproductive outcomes.

OBJECTIVE:

To assess the reproductive outcomes after minilaparotomic and laparoscopic myomectomy in patients wishing to conceive.

DESIGN:

Randomized controlled trial.

SETTING:

Departments of obstetrics and gynecology of the universities of Catanzaro, Rome, and Florence, Italy.
PATIENT(S): One hundred thirty-six women with symptomatic uterine leiomyomas or unexplained infertility.
INTERVENTION(S): Laparoscopic and minilaparotomic myomectomy.
MAIN OUTCOME MEASURE(S): Pregnancy, abortion, and live-birth rates.
RESULT(S): Between the laparoscopic and minilaparotomic groups no difference was observed in cumulative pregnancy, live-birth, and abortion rates, whereas pregnancy and live-birth rates per cycle, and time to first pregnancy and live-birth were significantly higher in the laparoscopic than in the minilaparotomic group. Categorizing the patients according to surgical indication for myomectomy, cumulative pregnancy rate, pregnancy, and live-birth rates per cycle, and time to first pregnancy and live-birth were significantly better after laparoscopic myomectomy in symptomatic patients, whereas all reproductive outcomes were similar between the two groups in patients with unexplained infertility.
CONCLUSION(S): Minilaparotomic and laparoscopic myomectomy improves in a similar manner the reproductive outcomes in patients with unexplained infertility, whereas the laparoscopic approach provides the best benefits in fertile patients with symptomatic leiomyomas.