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• W4244755164 abstract "We very much appreciate the interest expressed by Dr. Harmanli in our article “Effect of Myomectomy on the Outcome of Assisted Reproductive Technologies” (1Suitey E.S. Minjarez D.A. Stevens J.M. Schoolcraft W.B. Effect of myomectomy on the outcome of assisted reproductive technologies.Fertil Steril. 2005; 83: 1473-1479Abstract Full Text Full Text PDF PubMed Scopus (89) Google Scholar). Dr. Harmanli expressed concern about the selection of control groups. This issue was addressed in some detail in the third paragraph of the discussion section. There is no question that an ideal study design would be prospective and randomized, in which two additional groups of patients would be included: one group with untreated submucosal leiomyomata that would have otherwise been resected hysteroscopically, and an additional group with untreated large submucosal or intramural leiomyomata, which would otherwise have been resected at laparotomy. However, given the body of data suggesting a deleterious effect of clinically significant leiomyomata on assisted reproductive technology outcome as measured by ongoing pregnancy, live birth, and implantation rates, we did not feel that it would be ethical, acceptable, or practical to allow a control group of patients with such lesions to cycle in a potentially suboptimal environment (2Hart R. Khalas Y. Yeong C.-T. Seed P. Taylor A. Braude T. A prospective controlled study of the effect of intramural fibroids on the outcome of assisted conception.Hum Reprod. 2001; 16: 2411-2417PubMed Google Scholar, 4Surrey E. Lietz A. Schoolcraft W. Impact of intramural leiomyomata in patients with a normal endometrial cavity on in vitro fertilization–embryo transfer cycle outcome.Fertil Steril. 2001; 75: 405-410Abstract Full Text Full Text PDF PubMed Scopus (158) Google Scholar). We did, however, only resect those lesions that we felt were most likely to be clinically significant. One could certainly make a case that perhaps the fibroids did not exert a deleterious outcome at all. However, a significant body of literature would refute this concept.3Elder-Geva T. Meagher S. Healy D. McLachlan Y. Brebeny S. Wood C. Effect of intramural, subserosal, and submucosal uterine fibroids on the outcome of assisted reproductive technology treatment.Fertil Steril. 1998; 70: 687-691Abstract Full Text Full Text PDF PubMed Scopus (252) Google Scholar We would also concur that, although the sample sizes were indeed small, this represents, to our knowledge, the largest study published to date that evaluates the effect of myomectomy on assisted reproductive technology cycles. There is no question that an appropriately designed prospective, randomized trial would allow us to reach definitive conclusions. The design of the study was considered to be retrospective and case control. Typically, a case control trial is a study that begins by identifying individuals with a disease (cases) and individuals without a disease (controls). A cohort trial, however, is typically a prospective study that begins by identifying individuals with and without a factor being investigated. It would seem that the design of the current study represents components from each design, although clearly this is a retrospective trial in nature and could perhaps be better defined as a retrospective cohort study. Important features of study designFertility and SterilityVol. 84Issue 4PreviewI enjoyed reading the article by Dr. Surrey and his colleagues, “Effect of myomectomy on the outcome of assisted reproductive technologies” (1). However, I would like to correct their designation of this work as a case control study. Although the data were collected retrospectively, it still is a cohort study because the patients were not classified based on an outcome measure. Instead, by design, the cases and controls were determined according to their exposure to specific interventions, which are “precycle hysteroscopic or abdominal myomectomy and subsequent fresh IVF-ET or oocyte donation” as clearly indicated by the authors in the abstract. Full-Text PDF" @default.
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