Myomectomy and tuboplasty performed at the same time in cases of distal tubal obstruction with associated fibroids.

OBJECTIVE: To compare pregnancy rates and outcomes in patients who underwent tuboplasty alone versus those who had simultaneous myomectomy and tuboplasty for distal tubal occlusion. STUDY DESIGN: One hundred eighty-eight patients underwent tuboplasty alone. An additional 56 were treated by both myomectomy and tuboplasty, and 8 others underwent tuboplasty, leaving the myomas in situ. RESULTS: Of the 188 patients who underwent tuboplasty alone, 47.90% (90 patients) became pregnant; of these, 24 (26.7%) had a spontaneous miscarriage, 14 (15.6%) developed an ectopic pregnancy, and 52 (57.7%) achieved a viable birth. By comparison, of the 56 patients who had both tuboplasty and myomectomy, 53.6% (30 patients) conceived: of these, 11 (36.7%) miscarried, 7 (23.3%) developed ectopic pregnancies, and 12 (40.0%) achieved viable births. Of the eight patients who underwent tuboplasty while leaving the myoma in situ, five became pregnant, resulting in three viable births (37.5%) and two spontaneous abortions (25%). The number of pregnancies, ectopic gestations, miscarriages and viable births in the two former groups showed no statistical differences. (For the eight patients with the myoma in situ, the number was too small for statistical analysis.) CONCLUSION: Because there is no disadvantage to performing myomectomy at the time of tuboplasty for distal tubal occlusion, the combined surgical approach should be the procedure of choice rather than performing myomectomy in a separate operation later.