Pregnancy after complex myomectomy: neither age of patient nor size, number or location of fibroids should be a barrier

This 45-year-old woman was a tertiary referral to our Myoma Service with a diagnosis of symptomatic fibroids confirmed by ultrasound and MRI. Clinically, the uterine mass was equivalent to 28–30 weeks gestation. In view of her age and massive fibroids with menorrhagia, she had previously been offered a hysterectomy but wished to preserve fertility potential and requested a myomectomy. Her preoperative haemoglobin was 11.7 g/dl. After appropriate counseling and consent, we performed an open myomectomy (as described below) in June 2009. We removed 55 fibroids weighing 1700 g via two uterine incisions, one anterior and the other posterior and both vertical. Some of the fibroids were huge and highly vascular with blood supply from large sinuses running over their surfaces. There were no palpable or visible residual fibroids at the end of the procedure. The uterine cavity was not breached and estimated blood loss was 2300 ml. She received two units of blood transfusion. Six months after myomectomy she sought eggdonation IVF in Spain. The uterine cavity assessment was performed by hysteroscopy prior to beginning of the IVF treatment. It showed presence of few flimsy synichae within an otherwise regular uterine cavity. She conceived following the first treatment cycle. She had an entirely uncomplicated pregnancy and in June 2011, at 38 weeks gestation and at the age of 47 years, she underwent a caesarean section delivery of a healthy female infant weighing 3.47 Kg with Apgar scores of 9 and 10, and had an uneventful postoperative recovery.