Uncertainty exists about the effect of myomectomy (removal of fibroid) on fertility outcomes. Myomectomy for intramural myomas had no significant effect on pregnancy . Hysteroscopic myomectomy has no detrimental effect upon implantation. A recent review comparing hysteroscopic myomectomy compared with timed intercourse in women aged less than 37 years with unexplained subfertility and submucous fibroids of diameter ≤40 mm with or without associated myomas . No effect on the rates of pregnancy loss and of clinical pregnancies was observed between the two strategies.
Few data are available about the effect of myomectomy on the obstetric risk and perinatal outcomes. Uterine rupture is a rare complication after myomectomy. Fortunately, it is a rare event, occurring after 0.2% and 0.26% of myomectomies after laparotomy and laparoscopy,. A retrospective observational study compared perinatal outcomes after laparoscopic myomectomy versus abdominal myomectomy, and found no difference in the rates of emergencies in pregnancies, such as low Apgar score, non-reassuring fetal heart rate patterns and intrauterine fetal death.
At the moment, the effects of other new medical (i.e. ulipristal acetate) and surgical (i.e. focused ultrasound/radiofrequency ablation) treatments for uterine fibroids on pregnancy and neonatal complications are under investigation.