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Objective To determine the effects of fibroids, and their removal, on ART outcomes. Materials and methods Single institution retrospective cohort study of infertility patients who underwent myomectomy prior to either in vitro fertilization (IVF) or intrauterine insemination (IUI) between August 2006 and October 2015 (N = 49). Two separate control groups were established: 1) women with fibroids left in situ during the ART process (N = 76), and 2) women with no fibroids (N = 103). The study was powered to detect a difference between a 42%, 11%, and 25% live birth (LB) rate in the myomectomy, fibroids in situ, and no fibroids groups at P Results There were no significant differences in IVF cycle parameters between groups. Fibroids that were either submucosal or intramural with associated cavity distortion were significantly more likely to be removed. Amongst women undergoing IVF, the cumulative incidence of clinical pregnancy (CP) was significantly higher in the myomectomy group than the in situ or no fibroids groups. Women who underwent pre-IVF myomectomy also achieved CP more quickly. Cumulative LB rates did not differ significantly amongst women undergoing IVF. CP and LB rates per cycle were similar between myomectomy, in situ, and no fibroids groups (CP 49% vs. 37.5% vs. 54.4%, P = 0.21; LB 41.7% vs. 27.1% vs. 43.9%, P = 0.17). Discussion IVF outcomes appear to be improved by judicious removal of clinically significant fibroids. Further prospective studies are required to confirm the role of fibroids, and their removal, on ART outcomes before advocating for routine myomectomy amongst women with fibroids undergoing ART.

There is an ongoing debate regarding the benefits and drawbacks of the various routes of hysterectomy. A number of studies have examined overall quality of life outcomes as well as specific patient-reported outcomes including physical, psychosocial, and sexual functioning after hysterectomy. Existing studies have used varied methodologies with widely heterogeneous results, but patient satisfaction appears to be very high after laparoscopic hysterectomy, with many studies favoring the laparoscopic approach over other routes of hysterectomy. There are many opportunities for further investigation into the impact of laparoscopic hysterectomy on quality of life-an outcome measure that may be 1 of the most important in surgeries for benign indications.