A comparative analysis of the impact of three distinct laparoscopic myomectomy techniques on ovarian reserve: a randomized clinical trial.

Abstract

Purpose: Laparoscopic myomectomy is one of the preferred surgical treatments for symptomatic uterine fibroids. This study aimed to compare the effects of laparoscopic myomectomy with temporary uterine artery occlusion (TUAO), permanent uterine artery occlusion (PUAO), and vasopressin injection (VPI) on ovarian reserve in women with symptomatic uterine leiomyomas.

Methods: This randomized clinical trial (RCT) study was conducted on women with symptomatic uterine fibroids referred to Shahid Beheshti and Al-Zahra Hospitals in Isfahan, Iran, from January 2024 to July 2024. A total of 54 women were included, with 18 women in each group. The women were randomly grouped based on the used techniques of TUAO, PUAO, and VPI. Moreover, ovarian reserve marker, including anti-Mullerian hormone (AMH) level, were measured before and after surgery. This parameter was evaluated 3 months after surgery for all patients. Also, the amount of hemoglobin was measured before and after 24 h after surgery for participants in each method.

Results: TUAO, PUAO and VPI laparoscopic myomectomy techniques had almost similar effects on ovarian reserve. The AMH level before the surgery in TUAO, PUAO, and VPI groups was reported as 3.87 ng/mL, 3.42 ng/mL, and 3.57 ng/mL, respectively. The AMH level (3 month) after the surgery was 3.78 ng/mL, 3.34 ng/mL and 3.48 ng/mL, respectively. No significant difference was reported between AMH levels among the methods before and after the surgery (P = 0.27, P = 0.12, and P = 0.29, respectively). The Hb level before the surgery in TUAO, PUAO, VPI was 11.23 g/dL, 11.55 g/dL and 11.67 g/dL, respectively. The Hb level after the surgery (24 h) was reported as 10.95 g/dL, 11.31 g/dL and 11.25 g/dL, respectively. No significant difference was reported between Hb levels among the methods before and after the surgery (P = 0.36, P = 0.31, and P = 0.13, respectively).

Conclusion: As the choice of technique may depend on the factors such as surgeon preference and patient-specific factors, findings of this study have important implications for women undergoing LM and also highlight the need for further studies on the long-term effects of these techniques on ovarian reserve with larger sample sizes.