Myomectomy before IVF: Which fibroids need to be removed?

The decision to do a Myomectomy before and IVF cycle is not an easy one. You will always be faced with the “Do you think it is essential, doctor?” question. To answer this question you have to have clear-cut evidence that this woman will not get pregnant following an IVF cycle except if she had a Myomectomy. Or if she gets pregnant, she will probably lose her baby because of the fibroids her uterus carries. We have to deploy proper judgment in each individual case based on the age as well as the number and size of the intramural myomas. A single myoma of 4cm size or less that is not encroaching on the cavity in a woman in her late thirties may deserve a single trial to get pregnant through IVF without Myomectomy. If that fails or ends in a miscarriage, she may be counseled for surgery before the second trial. However, larger and multiple myomas, especially in a younger patient may deserve surgery before enrolling her in her first IVF cycle. Single sub-serous myomas of sizes less than 5cm may well be ignored and the patient is allowed to go through IVF. However, if larger or associated with intramural myomata, surgery may be considered prior to enrolling her in an IVF cycle