Factors Analysis Of Postoperative Fertility After Myomectomy

Objective:Uterine myomas are the most common tumors of the female genital tract. Many women suffering from uterine myomas request fertility. Study of myomectomy after fertility has not been determined. We selected some women have fertility requirements after myomectomy in our hospital, investigation and study fertility condition after surgery, analyze the patient age at surgery, uterine fibroids type, size, quantity, location and whether combined with other infertility factors and postoperative pregnancy rate in relations, and different degree of influence on postoperative fertility surgical uterine fibroids and pelvic surgery adhesions, in order to get more objective statistical data required to have birth patients with uterine fibroids are more scientific and rational treatment of reference, to achieve the best therapeutic effect.Materials and Methods:From January of 2003 to December of 2008, there are totally 816 in our hospital received myomectomy, and the pathology results confirmed uterine fibroids between the ages of 18 and 35.418 cases have not fertility,330 cases are selected as study cases single uterine fibroids single line more than 4cm in diameter.35 cases have Vaginal myomectomy or TCRM are excluded,51 cases have no fertility aspiration,93 cases unwilling to accept the follow-up due to privacy reasons, or admission information is not complete cause could not be contacted. Not natural conception after surgery accepted ART include 14 cases accepted IVF-ET and AI. Total 193 cases are exluded this study and 137 cases are included. According to People's Health Publishing House "Obstetrics and Gynecology" (seventh edition) infertility diagnostic criteria, a normal sex life before surgery 1 year without contraception, not pregnant a total of 37 patients were infertile; the remaining 100 free of infertile patients. Collecting the information of patients age, weight, preoperative complaints, surgical history, history of diseases, pregnancy history, and its specific circumstances, menstrual history, preoperative B-mode ultrasound examination of data, type of surgery, intraoperative findings specific circumstances, the operation time, blood loss, postoperative conditions, length of stay, the time after birth, and other indicators of pregnancy after a detailed inquiry and record, and form the data for statistical analysis. Descriptive analysis, qualitative data using frequency and percentage; quantitative data consistent with the normal distribution with mean and standard deviation, does not meet the normal distribution using the median. Single factor analysis, the dependent variable is the situation after birth (binary data, fertility or birth), categorical variables chi-square test or fisher select exact; quantitative data, select the single factor logistic regression. In univariate analysis, P<0.1, and clinical variables that may be considered affecting patients after surgery of uterine fibroids fertility are selected as variables into multivariate logistic regression, adjusted the interaction between various factors, eliminate cross confounding factors, analysis of various factors The independent effect after the actual situation of fertility.Results:In this study,137 cases of myomectomy patients,108 patients have successful pregnancy after surgery (78.83%),37 cases of infertility patients,22 cases of successful pregnancy after surgery (59.46%),100 patients of no infertile group,86 cases of successful pregnancies (86.00%) after surgery.14 patients with a history of spontaneous abortion,10 cases all successfully pregnancy to delivery(71.43%), no spontaneous abortion happens again.In univariate analysis these three factors have statistical significance as infertility or not preoperation, different degrees of fibroids or pelvic adhesions and the patients age. Abdominal or intraperitoneal microscope is no difference in pregnancy rate after removing the fibroids; Uterine fibroids type, location, size, quantity the operation into the uterine cavity or not, dose not affect pregnancy rate after surgery.By multivariate logistic analysis, P value of age and pelvic adhesions entry<0.05, patients with uterine fibroids after their pregnancy was statistically significant difference between effects, and the risk factors for pregnancy after all, the older, the combined more severe pelvic adhesions, the lower the chance of pregnancy after. Preoperative history of infertility, and pregnancy after myomectomy were not different.Conclusions:1. For infertile patients with uterine fibroids, myomectomy can increase the fertility rate.2. Patients have no history of infertility may occur after removing the fibroids infertility situation.3. Patients with history of spontaneous abortion decreased rate of spontaneous abortion after removing the fibroids.4. Patients older time of surgery, the lower the pregnancy rate is after.5. Patients have uterine fibroids associated with severe pelvic adhesion, even if intraoperative release of the adhesions, the pregnancy rate was still not associated with severe postoperative adhesions significantly reduced the population.6. Uterine fibroids type, location, size, quantity, surgical and the operation into the uterine cavity or not, dose not affect pregnancy rate after surgery.