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Optimal surgical approaches to minimally invasive myomectomy for the fertility patient

Year: 2026
Type: article
Abstract: Case presentationPatient background A 34-year-old G1P0010 woman presents with uterine fibroids and a two-year history of infertility.She reports heavy menstrual bleeding and bulk-related symptoms.She has history of prior dilation and curettage for management of a missed abortion, no significant medical comorbidities, and normal ovarian reserve testing.She strongly desires future pregnancy and seeks fertility-sparing surgical management. Presenting problemPelvic magnetic resonance imaging (MRI) demonstrates multiple intramural and transmural leiomyomas, with the largest measuring 4.5 cm, including an International Federation of Gynecology and Obstetrics type 2-5 fibroid distorting the endometrial cavity.Given the fibroid burden and depth, the patient seeks counseling regarding the safest and most effective minimally invasive surgical approach that maximizes fibroid removal while preserving and enhancing uterine function for future pregnancy. Initial workupMagnetic resonance imaging mapping is reviewed to delineate fibroid number, size, location, and relationship to the endometrial cavity.Preoperative hemoglobin is mildly reduced.There is concern for diffuse adenomyosis on imaging, but no additional pelvic pathology.The patient is referred to a reproductive surgeon with expertise in complex myomectomy. Clinical questionIn reproductive-aged patients with complex fibroid burden, which surgical techniques and technologies optimize fertility outcomes in minimally invasive myomectomy while preserving uterine function and obstetrical safety?(F S Rep ® 2026;7:346-50.©2026 by American Society for Reproductive Medicine.)
Source: F&S Reports
DOI: 10.1016/j.xfre.2026.08.006
Language: English
Field: Medicine
Open Access status: gold
Estimated APC paid: $2,000
OpenAlex ID: W7204196615
FWCI:
Cites: 28
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Related to: 10