Uterine-Preserving Myomectomy in Young Women: A Comprehensive Review of Fertility Outcomes

Background: Uterine fibroids (leiomyomas) represent a prevalent benign gynecological condition, particularly affecting women of reproductive age. Conservative surgical approaches, such as myomectomy, are increasingly prioritized in young patients to preserve fertility and maintain uterine integrity. This review evaluates the efficacy, perioperative considerations, and reproductive outcomes associated with different myomectomy techniques. Methods: A systematic literature analysis was conducted, focusing on studies involving laparoscopic, hysteroscopic, and abdominal myomectomy in women under 40 years old. Outcomes assessed included fibroid recurrence rates, postoperative fertility, pregnancy complications, and long-term gynecological health. Results: Myomectomy demonstrates high success rates in symptom relief (e.g., menorrhagia, pelvic pressure) and fertility preservation, with pregnancy rates exceeding 50% in most cohorts. However, minimally invasive techniques (e.g., laparoscopic myomectomy) are associated with reduced adhesions and shorter recovery compared to laparotomy. Recurrence remains a concern, with a 5-year incidence of 15–30%, necessitating individualized follow-up. Conclusion: Uterine-sparing myomectomy is a safe and effective intervention for young women with symptomatic fibroids. Surgical approach selection should consider fibroid characteristics, reproductive goals, and risk of recurrence. Further prospective studies are needed to optimize patient stratification and postoperative management.