A 38-year-old with a single 5 cm submucosal fibroid (FIGO type 1 — less than 50% intramural) and primary infertility is referred for treatment. The most appropriate initial approach is:

• A Laparoscopic myomectomy
• B Uterine artery embolisation (UAE)
• C Hysteroscopic myomectomy ✓
• D GnRH agonist pre-treatment for 3 months then reassess

Explanation

Submucosal fibroids distort the uterine cavity and impair implantation; their removal improves fertility outcomes. FIGO type 0 and 1 submucosal fibroids (entirely or predominantly intracavitary with <50% intramural component) are ideally managed by hysteroscopic myomectomy — a minimally invasive procedure with no uterine incision, rapid recovery, and no risk of uterine rupture in future pregnancies. Laparoscopic myomectomy is appropriate for intramural or subserosal fibroids. UAE is contraindicated in women desiring fertility due to risk of premature ovarian failure and abnormal placentation.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.