Myomas are the most common tumors found in the female genital tract. They are estimated to occur in 20 and 50 percent of women in their later reproductive years. However, not all myomas need to be removed. Patients with no symptoms who want to get pregnant can be given a six- to 12-month trail of conception. However, some myomas cause irregular bleeding, heavy menstrual flow, abdominal distension, or other symptoms. Symptomatic women who want to conceive should consider surgery.
For myomas located only in the uterine cavity (subserosal), a hysteroscopic approach is performed. For myomas located in the muscle (intramural), an open approach (abdominal myomectomy) is often recommended for patients wishing to become pregnant. This operation is traditionally done through a laparotomy via a 'bikini' or transverse incision. While some physicians perform laparoscopic myomectomies, there have been numerous reports of uterine rupture during pregnancy and labor that can result in the loss of the pregnancy. There is still debate in the fertility literature whether laparoscopic myomectomy should be performed in patients who intend to get pregnant.