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• W3177864215 abstract "BackgroundMyomas are one of many factors that may interfere with a woman’s ability to have a baby; they are the causative agent in 5% to 10% of infertility cases.1 Significant improvements in spontaneous pregnancy rates in infertile patients after myomectomy compared to nonsurgical management has been demonstrated.2 While minimally invasive myomectomies are superior to abdominal myomectomies in terms of surgical complications, it remains unknown how assisted reproductive technology (ART) pregnancies are impacted by a minimally invasive approach.3-5ObjectiveTo compare pregnancy outcomes after euploid frozen embryo transfer (FET) in patients with a history of abdominal (ABD) versus laparoscopic/robotic-assisted (LSC) myomectomy.Materials and MethodsThis is a retrospective cohort study of patients with a history of ABD or LSC myomectomy undergoing In Vitro Fertilization (IVF) and subsequent euploid FET at a large urban university-based fertility center between 2014 and 2019. The primary outcomes were clinical pregnancy rate (PR) and livebirth/ongoing pregnancy (LB/OP) rate after euploid FET in patients with prior myomectomy. Statistical analysis was performed using students t-test and Chi-Square, with p<0.05 considered significant.Results115 euploid embryo transfers were included from 74 unique patients. 42.6% (n=49) of cases had a pre-transfer ABD myomectomy compared to 57.4% (n=66) of cases with a LSC myomectomy. 5 patients had a repeat myomectomy; two of same mode and three ABD, then LSC. The average BMI was similar in each group (ABD 26.2kg/m2 vs. LSC 25.3kg/m2, p=0.99). The median number of removed fibroids was higher in the ABD group (ABD 4.5 (range: 1-33) vs. LSC 3 (range: 1-25), p=0.67), as was the average size of the largest fibroid (ABD 8.4cm (range: 3-20cm) vs. LSC 5.5cm (range: 1.2-16cm), p=0.27). However, these differences were not significant. LSC patients had transfers sooner after surgery (LSC: mean 16months (range: 2.3-58months) vs. ABD: mean 43months (range: 3-163months). p<0.01). More patients with prior ABD myomectomy required a second hysteroscopic cavity intervention prior to FET (ABD 28.6% (n=8) vs. LSC 10.9% (n=5), p=0.03), including lysis of adhesions or submucous myoma resection. Clinical PRs were higher in the LSC cohort (ABD 51.0% (25/49) vs. LSC 63.6% (42/66), but not statistically so (p=0.41). Total LB/OP rates including all transfers were also higher, but again without significance (ABD 40.8% (20/49) vs. LSC 51.5% (34/66), p=0.78). Rates of biochemical, ectopic and spontaneous abortion were overall low in this cohort and not significantly different (Table 1).ConclusionsMinimally invasive approaches to myomectomies have known surgical outcome advantages, and we show that outcomes of laparoscopic approach are no worse than those following abdominal cases. Our data suggests superiority of laparoscopy, however more cases need to be collected to establish statistical significance.Financial SupportNoneReferences:1. Buttram, V., Reiter, R. (1981). Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 36, 433-435.2. Bulletti, C., De Ziegler, D., Polli, V., Flamigni, C. (1999). The role of leiomyomas in infertility. J Am Assoc Gynecol Laparosc. 6, 441-445.3. Advincula, A, Xu, X, Goudeau, S, Random, S. (2007). Robotic-assisted laparoscopic myomectomy versus abdominal myomectomy: A comparison of short-term surgical outcomes and immediate costs. Journal of Minimally Invasive Gynecology. 14, 698 - 705.4. Sizzi, O, Rossetti, A, Malzoni, M, Minelli, L, Grotta, F, Soranna, L, Panuzi, S. (2007). Italian multicenter study on complications of laparoscopic myomectomy. Journal of Minimally Invasive Gynecology. 14, 453 - 462.5. Stringer, N, Walker, J, Meyer, P. (1997). Comparison of 49 laparoscopic myomectomies with 49 open myomectomies. J Am Assoc Gynecol Laparosc. 4, 457 – 464. BackgroundMyomas are one of many factors that may interfere with a woman’s ability to have a baby; they are the causative agent in 5% to 10% of infertility cases.1 Significant improvements in spontaneous pregnancy rates in infertile patients after myomectomy compared to nonsurgical management has been demonstrated.2 While minimally invasive myomectomies are superior to abdominal myomectomies in terms of surgical complications, it remains unknown how assisted reproductive technology (ART) pregnancies are impacted by a minimally invasive approach.3-5 Myomas are one of many factors that may interfere with a woman’s ability to have a baby; they are the causative agent in 5% to 10% of infertility cases.1 Significant improvements in spontaneous pregnancy rates in infertile patients after myomectomy compared to nonsurgical management has been demonstrated.2 While minimally invasive myomectomies are superior to abdominal myomectomies in terms of surgical complications, it remains unknown how assisted reproductive technology (ART) pregnancies are impacted by a minimally invasive approach.3-5 ObjectiveTo compare pregnancy outcomes after euploid frozen embryo transfer (FET) in patients with a history of abdominal (ABD) versus laparoscopic/robotic-assisted (LSC) myomectomy. To compare pregnancy outcomes after euploid frozen embryo transfer (FET) in patients with a history of abdominal (ABD) versus laparoscopic/robotic-assisted (LSC) myomectomy. Materials and MethodsThis is a retrospective cohort study of patients with a history of ABD or LSC myomectomy undergoing In Vitro Fertilization (IVF) and subsequent euploid FET at a large urban university-based fertility center between 2014 and 2019. The primary outcomes were clinical pregnancy rate (PR) and livebirth/ongoing pregnancy (LB/OP) rate after euploid FET in patients with prior myomectomy. Statistical analysis was performed using students t-test and Chi-Square, with p<0.05 considered significant. This is a retrospective cohort study of patients with a history of ABD or LSC myomectomy undergoing In Vitro Fertilization (IVF) and subsequent euploid FET at a large urban university-based fertility center between 2014 and 2019. The primary outcomes were clinical pregnancy rate (PR) and livebirth/ongoing pregnancy (LB/OP) rate after euploid FET in patients with prior myomectomy. Statistical analysis was performed using students t-test and Chi-Square, with p<0.05 considered significant. Results115 euploid embryo transfers were included from 74 unique patients. 42.6% (n=49) of cases had a pre-transfer ABD myomectomy compared to 57.4% (n=66) of cases with a LSC myomectomy. 5 patients had a repeat myomectomy; two of same mode and three ABD, then LSC. The average BMI was similar in each group (ABD 26.2kg/m2 vs. LSC 25.3kg/m2, p=0.99). The median number of removed fibroids was higher in the ABD group (ABD 4.5 (range: 1-33) vs. LSC 3 (range: 1-25), p=0.67), as was the average size of the largest fibroid (ABD 8.4cm (range: 3-20cm) vs. LSC 5.5cm (range: 1.2-16cm), p=0.27). However, these differences were not significant. LSC patients had transfers sooner after surgery (LSC: mean 16months (range: 2.3-58months) vs. ABD: mean 43months (range: 3-163months). p<0.01). More patients with prior ABD myomectomy required a second hysteroscopic cavity intervention prior to FET (ABD 28.6% (n=8) vs. LSC 10.9% (n=5), p=0.03), including lysis of adhesions or submucous myoma resection. Clinical PRs were higher in the LSC cohort (ABD 51.0% (25/49) vs. LSC 63.6% (42/66), but not statistically so (p=0.41). Total LB/OP rates including all transfers were also higher, but again without significance (ABD 40.8% (20/49) vs. LSC 51.5% (34/66), p=0.78). Rates of biochemical, ectopic and spontaneous abortion were overall low in this cohort and not significantly different (Table 1). 115 euploid embryo transfers were included from 74 unique patients. 42.6% (n=49) of cases had a pre-transfer ABD myomectomy compared to 57.4% (n=66) of cases with a LSC myomectomy. 5 patients had a repeat myomectomy; two of same mode and three ABD, then LSC. The average BMI was similar in each group (ABD 26.2kg/m2 vs. LSC 25.3kg/m2, p=0.99). The median number of removed fibroids was higher in the ABD group (ABD 4.5 (range: 1-33) vs. LSC 3 (range: 1-25), p=0.67), as was the average size of the largest fibroid (ABD 8.4cm (range: 3-20cm) vs. LSC 5.5cm (range: 1.2-16cm), p=0.27). However, these differences were not significant. LSC patients had transfers sooner after surgery (LSC: mean 16months (range: 2.3-58months) vs. ABD: mean 43months (range: 3-163months). p<0.01). More patients with prior ABD myomectomy required a second hysteroscopic cavity intervention prior to FET (ABD 28.6% (n=8) vs. LSC 10.9% (n=5), p=0.03), including lysis of adhesions or submucous myoma resection. Clinical PRs were higher in the LSC cohort (ABD 51.0% (25/49) vs. LSC 63.6% (42/66), but not statistically so (p=0.41). Total LB/OP rates including all transfers were also higher, but again without significance (ABD 40.8% (20/49) vs. LSC 51.5% (34/66), p=0.78). Rates of biochemical, ectopic and spontaneous abortion were overall low in this cohort and not significantly different (Table 1). ConclusionsMinimally invasive approaches to myomectomies have known surgical outcome advantages, and we show that outcomes of laparoscopic approach are no worse than those following abdominal cases. Our data suggests superiority of laparoscopy, however more cases need to be collected to establish statistical significance. Minimally invasive approaches to myomectomies have known surgical outcome advantages, and we show that outcomes of laparoscopic approach are no worse than those following abdominal cases. Our data suggests superiority of laparoscopy, however more cases need to be collected to establish statistical significance." @default.
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• W3177864215 title "MYOMECTOMY – DOES ROUTE IMPACT EUPLOID EMBRYO TRANSFER OUTCOMES?" @default.
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