A 36-year-old woman with symptomatic fibroids desires fertility. MRI shows a single 8 cm FIGO Type 3 intramural fibroid abutting but not distorting the endometrial cavity, and a separate 3 cm Type 0 submucosal fibroid. Which factor is the primary indication for myomectomy before conception in this patient?

• A The 8 cm size of the intramural fibroid alone
• B The FIGO Type 3 intramural location
• C The patient's age of 36 years
• D The presence of the submucosal fibroid (Type 0) ✓

Explanation

Submucosal fibroids (FIGO Types 0, 1, 2) impair fertility by distorting the endometrial cavity and interfering with implantation, and their removal improves conception rates. Intramural fibroids that do not distort the cavity (Type 3) have a less clear impact on fertility; myomectomy is considered if they exceed 4 to 5 cm or cause symptoms, but cavity distortion is the stronger indication.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.