Leiomyomas, Fertility and ART
Uterine myomas have been of clinical interest for centuries. The first abdominal myomectomy was performed by Chelms in 1838 with a pre-operative diagnosis of an ovarian tumor.1 The first series of myomectomies was reported by Alexander of Liverpool in 1898.2 Eleven cases were reported in Alexander’s series. There were three deaths (not an unusual mortality rate for the 1800s). For a period of time, a myomectomy was referred to as an “Alexander operation”. In 1890, Martin reported a series of 96 myomectomies performed specifically to conserve uterine function.3 In Martin’s series, 18 of 96 died, a rate not dissimilar to hysterectomy at that time. The problems of high mortality, hemorrhage, and sepsis made myomectomy hazardous, and the procedure never achieved popularity.