Intramural myomas and fertility: To operate or not?

Intramural uterine myomas are very common among women of reproductive age, but their impact on natural and assisted fertility remains controversial. Although international federation of gynecology and obstretrics type 3 myomas may have the most negative impact on receptivity, available data are still not convincing. Surgical removal of these myomas is encouraged when they are symptomatic, but myomectomy for fertility-only reasons cannot be offered in daily clinical practice before in vitro fertilization treatment, as data are still inconclusive. Moreover, myomectomy is strongly associated with short and long-term complications, some of which may also affect the fertility outcome. A better understanding of the association between intramural myomas and fertility may open up new perspectives for the individualized management of infertile women with uterine myomatous masses.