Comment: The quality of evidence is downgraded by imprecise results (few outcome events) and by potential reporting bias (only few small studies).
A Cochrane review included 2 studies with a total of 298 subjects. In women with otherwise unexplained subfertility and submucous fibroids, there is was a trend for benefit with hysteroscopic myomectomy compared to regular fertility-oriented intercourse during 12 months for clinical pregnancy (39% vs 21%; OR 2.4, 95% CI 0.97 to 6.2, n=94). The hysteroscopic removal of polyps prior to intrauterine insemination increases the odds of clinical pregnancy compared to diagnostic hysteroscopy and polyp biopsy only ( 63% vs 28%, OR 4.4, 95% CI 2.5 to 8.0; n=204).
Another Cochrane review included 3 studies with a total of 271 subjects. One study examined the effect of myomectomy on reproductive outcomes and showed no clear evidence on the clinical pregnancy rate for intramural (OR 1.88, 95% CI 0.57 to 6.14), submucous (OR 2.04, 95% CI 0.62 to 6.66), combined intramural and subserous (OR 2.00, 95% CI 0.40 to 10.09) and combined intramural submucous fibroids (OR 3.24, 95% CI 0.72 to 14.57). Similarly, there was no evidence for a significant effect of myomectomy for any of the described types of fibroids on the miscarriage rate. In comparison of open versus laparoscopic myomectomy no evidence for a significant effect on the live birth rate was found in 2 trials (OR 0.80, 95% CI 0.42 to 1.5; n=177), clinical pregnancy rate (OR 0.96, 95% CI 0.52 to 1.78; n=177), miscarriage rate, preterm labour rate, and caesarean section rate.
Date of latest search: 8 September 2014