The fibroid removal in sterility treatment ‘‘FIRST’’ survey: a European Society of Gynecology Online Questionnaire

Abstract

The clinical management of uterine fibroids in the context of infertility is characterized by significant heterogeneity. The aim of our study was to record the participants’ views and clinical practices regarding minimally invasive, fertility-sparing management of fibroids, focusing on fertility outcomes. Methods: An online survey was distributed to members of the European Society of Gynecology (ESG), using a questionnaire comprising 27 questions. Questions 1 to 5 related to the participants’ background, while questions 6 to 27 related to the clinical management of fibroids. Results: A total of 98 participants completed the survey, of whom 83% (n = 82) practiced in European countries and 43% (n = 42) had completed specialist training in minimally invasive gynecological surgery. For FIGO 0–II fibroids, hysteroscopic removal was recommended by 94% (n = 92) of participants, although only 27% (n = 26) would do so in all cases, irrespective of the size and submucosal proportion. Anti-adhesion agents were used at least occasionally after the hysteroscopic removal of FIGO 0–II fibroids by 51% (n = 50) of participants. A clinically significant fibroid size was recognized by 57% (n = 56) of participants for FIGO III fibroids and by 51% (n = 50) for FIGO IV fibroids. The opinion was almost evenly divided on whether the distance between an intramural, non-cavity-distorting fibroid and the junctional zone affected the decision for removal: 49% (n = 48) considered that it did not, whereas 51% (n = 50) considered that it did, citing variable cut-off values. Most participants favored minimal-access approaches over laparotomy, whereas the use of robot-assisted laparoscopy was limited. Conclusions: Our results confirm the significant variation in clinical practice associated with fibroid management and underline the need for standardized care, based on high-quality evidence.