Fibroma and Fertility: About Two Uncommon Case Reports and Review of the Literature - Abstract
Background: Uterine fibroids are a common pathology that occurs in 20% to 50% of women of childbearing age and are the most common benign tumor. The management of a woman with fibroids and a desire for pregnancy remains controversial because of the lack until recently of clear recommendations. This disease’s impact on the couple’s ability to conceive is often mentioned in the literature but the accountability isn’t clearly established. In order to preserve fertility, practitioners must choose between no therapy or conservative treatment of fibroids consisting of myomectomy whether by hysteroscopy, laparoscopy or laparotomy depending on the number, size and topography of the myomas.
Case presentation: We hereby report two cases of patients who presented with primary infertility of respectively ten and eight years without any other etiology than a polymyomatous uterus. Laparotomy polymyomectomy performed in both patients allowed us to remove all the fibroids and allowed the patients to become pregnant and have their first child, respectively after 21- and 25-months post-surgery.
Discussion: Even today, there is insufficient evidence to conclude that uterine fibroids reduce the likelihood of pregnancy. However, it has been shown that in the case of myomas deforming the uterine cavity, myomectomy would result in pregnancy rates almost equivalent to the general population. Infertility management must of course take into account the patient as a whole, but it is legitimate to reassure the patient that her chances of pregnancy after myomectomy will improve, whether by hysteroscopy, laparoscopy or even laparotomy for large multiple myomas such as the cases presented.