Beyond the incision: a retrospective comparison of laparotomy and minimally invasive myomectomy outcomes in terms of fertility

Background: Fibroids are the most common benign tumors of the female genital tract and are often linked to various clinical issues, including potential impairment of fertility. Surgical removal of fibroids can be performed via laparotomy, laparoscopy, or hysteroscopy. However, myomectomy can result in serious consequences. Thus, it is crucial to evaluate whether the surgery enhances fertility and, if so, to identify the most effective surgical approach. This retrospective study compared the fertility outcomes between minimally invasive myomectomy (laparoscopic and hysteroscopic) and laparotomy, post-operative outcomes recorded as type of conception, need of in vitro fertilization (IVF), pregnancy outcomes and complications. The staging was done based on International Federation of Obstetrics and Gynaecology (FIGO), and fertility outcomes were analysed and compared between the groups. Result: The study included 117 cases in minimally invasive myomectomy and 53 instances in laparotomy. Multiple fibroids were more common in both groups, with no significant difference. Uterine size was significantly smaller in the minimally invasive group (p = 0.001) whereas, adhesions were more frequent in the laparotomy group (p = 0.03). IVF success rate in the minimally invasive group was 61.1%, while it was 50% in the laparotomy group. In FIGO types 0–2, conception occurred in 2.5% of the minimally invasive group, with 1.7% resulting in live births; no patients conceived in the laparotomy group. In FIGO types 6–7, 6.8% of patients in the minimally invasive group developed complications, compared to 2.6% in the laparotomy group, with live birth rates of 2.7% and 1.8%, respectively. Conclusion: Minimally invasive myomectomy demonstrated a favorable trend in conception and live birth rates, particularly among women with FIGO types 3–7 fibroids. While some randomized trials have reported no significant difference in pregnancy rates between laparoscopy and laparotomy, the minimally invasive approach appears to offer advantages in terms of safety and recovery.