Summary of findings 2. Laparoscopic myomectomy compared to myomectomy by laparotomy or mini‐laparotomy for fibroids for infertility.
| Laparoscopic myomectomy compared to myomectomy by laparotomy or mini‐laparotomy for fibroids for infertility | |||||||
| Patient or population:fibroids for infertility Setting: tertiary care Intervention: laparoscopic myomectomy Comparison: myomectomy by laparotomy or mini‐laparotomy | |||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE) | Comments | ||
| Without Laparoscopic myomectomy | With Laparoscopic myomectomy | Difference | |||||
| Live birth rate | 36.3% | 31.4% (19.3 to 46) | 5.0% fewer (17 fewer to 9.8 more) | OR 0.80 (0.42 to 1.50) | 177 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW a, b, c | |
| Preterm delivery rate | 3.3% | 2.3% (0.4 to 12.8) | 1.0% fewer (2.9 fewer to 9.5 more) | OR 0.70 (0.11 to 4.29) | 177 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW a, b, c | |
| Clinical pregnancy rate | 45.1% | 44.0% (29.9 to 59.3) | 1.0% fewer (15.2 fewer to 14.3 more) | OR 0.96 (0.52 to 1.78) | 177 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW a, b, c | |
| Ongoing pregnancy rate | 3.4% | 5.3% (0.9 to 26.1) | 2.0% more (2.5 fewer to 22.7 more) | OR 1.61 (0.26 to 10.04) | 115 (1 RCT) | ⊕⊝⊝⊝ VERY LOW a, b, c, d | |
| Miscarriage Rate | 6.6% | 8.1% (2.7 to 21.5) | 1.5% more (3.8 fewer to 14.9 more) | OR 1.25 (0.40 to 3.89) | 177 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW a, b, c | |
| Caesarean section rate | 27.5% | 20.9% (11.4 to 34.5) | 6.8% fewer (16.1 fewer to 7 more) | OR 0.69 (0.34 to 1.39) | 177 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW a, b, c, e | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; OR: Odds ratio; RCT: randomised controlled trial. | |||||||
| GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate. | |||||||
a Downgraded one level for imprecision; no sample size calculation and small number of events b Downgraded one level for imprecision; odds ratios and confidence intervals show opposing results c Downgraded one level for indirectness; participants with multiple (3 and over), cavity distorting or submucosal fibroids excluded d Downgraded one level for imprecision; only one study e Downgraded one level for inconsistency; significant heterogeneity