Design: Institution-based retrospective chart review from 2014-2022.

Setting: Academic teaching institutions that provide fertility, surgical and obstetric care.

Patients or Participants: Premenopausal women aged 18-52 who had a documented desire to conceive shortly after myomectomy.

Interventions: Women who met the above inclusion criteria underwent non-hysteroscopic myomectomy by a minimally invasive gynecologic surgeon and were followed for pregnancy outcomes.

Measurements and Main Results: 197 patients were included. Mean age was 36.1 years; 41(20.81%) patients were >40. 138 (70.05%) of the patients conceived; median time to conception was 16 months (6-month waiting period included). Live birth occurred in 78% of patients and median gestational age of delivery was 37 weeks with no uterine rupture events. The median follow-up time for the patients who did not conceive was 40.7 months. Using Cox proportional hazard models we used a backward elimination procedure to select variables which reached a p<0.05. Preoperative age ≥40 (HR=0.48, 95% CI 0.30-0.77, p=0.0023), diagnosis of endometriosis, tubal or adhesive disease (intraoperative or postoperative) (HR=0.62, 95% CI 0.43-0.90, p=0.0110), cavity entry (HR=0.56, 95% CI 0.38-0.82, p=0.0028) and size of largest myoma removed (HR=0.94 for additional 1cm, 95% CI 0.89-0.99, p= 0.0235). There was no significant difference in time to conception in those who used fertility treatment with or without a diagnosis of infertility.

Conclusion:

Patients with age > 40, those with endometriosis or pelvic adhesive disease, cavity entry, and those with larger myomas removed have increased time to conception after myomectomy. This may be related to coexisting causes of infertility, uterine scarring, and the development of intrauterine adhesions. Patients should have comprehensive preoperative counseling on their risk factors that could delay time to conception. This may help providers identify patients suffering from uterine myomas who may benefit from evaluation by a fertility specialist to attain their goals.