Fibroid Surgery Study Finds Similar Pregnancy Outcomes for Open and Minimally Invasive Myomectomy

Women with uterine fibroids who underwent surgical removal at a UK tertiary centre achieved clinical pregnancies and live births after the operation, but the surgical route chosen did not appear to influence their chances of conceiving, according to a retrospective cohort study published in Archives of Gynecology and Obstetrics. The study, conducted at Sheffield Teaching Hospitals between 2017 and 2019, compared open myomectomy, performed through laparotomy, with minimally invasive approaches, and found the two routes produced broadly similar post-operative outcomes, with one notable exception: hospital stays were significantly shorter after minimally invasive surgery.

Uterine fibroids are common benign tumours that, according to the researchers, contribute to infertility in approximately 3% of women. Submucosal fibroids and deep intramural fibroids can distort the uterine cavity, impairing implantation and live birth rates. Myomectomy, the surgical removal of fibroids while preserving the uterus, is offered when fertility preservation is desired, but the authors note that evidence supporting a genuine improvement in fertility outcomes after the procedure remains limited, regardless of which surgical approach is used. The study was designed to examine different surgical approaches and their associations with post-operative, fertility and pregnancy outcomes.

The research team reviewed electronic records, investigations and operation notes for all myomectomies carried out at the centre during the two-year study window. The primary outcome was clinical pregnancy after myomectomy. Secondary outcomes included live birth, post-operative complications and length of stay. Of 71 myomectomy cases, 23, or 32%, were performed because of subfertility, and 14 of those cases, 61%, involved primary infertility.

Following surgery, 13 of the 23 women with subfertility achieved a clinical pregnancy, a proportion of 56.5% with a 95% confidence interval of 36.5% to 75.0%. Eleven of the 23 cases resulted in a live birth, with a 95% confidence interval of 28.7% to 67.5%. The researchers were careful to characterise these figures as observational post-operative outcomes rather than evidence of surgical benefit, because the cohort lacked a non-surgical comparison group. Without such a group, it is not possible to determine how many of these pregnancies might have occurred without the operation.

On the central comparison, the study found no significant association between open and minimally invasive approaches and the chance of pregnancy, with a p-value of 0.339. Post-operative outcomes likewise showed no association with surgical approach, with all comparisons yielding p-values above 0.05. The one clear difference emerged in recovery: length of stay differed significantly between the approaches, with a p-value below 0.01. Minimally invasive surgery was associated with a median stay of 2 days, ranging from 0 to 4 days, while the open approach involved a median stay of 3 days, ranging from 1 to 8 days.

The authors concluded that in this cohort, a proportion of women achieved clinical pregnancies and live births after myomectomy, and that laparoscopic and open procedures had similar post-operative outcomes, with minimally invasive approaches showing reduced lengths of stay. They explicitly cautioned that interpretation is limited by the retrospective design, the small sample size and the absence of a non-surgical comparison group, and they called for further research to assess the relationship between myomectomy, surgical approach and reproductive outcomes.

Those limitations matter for how the findings should be read. A retrospective single-centre design means the data reflect what happened to patients treated at one hospital over a defined period, rather than the results of a planned comparison in which patients are assigned to different approaches. With only 23 subfertility cases, the confidence intervals around the pregnancy and live birth proportions are wide, spanning roughly 37% to 75% and 29% to 68% respectively, so the true rates in a broader population could differ substantially from the point estimates reported.

The study arrives amid a broader research effort to clarify when fibroid removal helps fertility. Related work published in recent years includes retrospective analyses comparing laparoscopic and open uterus-preserving myomectomy, propensity score-matched studies of pregnancy rates after myomectomy in women of reproductive age, and single-centre cohort studies of obstetric outcomes in pregnancies following removal of large fibroids. The Sheffield team’s contribution adds UK tertiary-centre data on both surgical and reproductive outcomes under one framework, while underscoring that the central clinical question, whether myomectomy improves fertility outcomes, still awaits answers from larger and better-controlled studies.

For clinicians counselling women with cavity-distorting fibroids who wish to preserve fertility, the study offers a snapshot of real-world practice at a single UK centre: pregnancy and live birth occurred in a substantial fraction of subfertility patients after surgery, complications did not differ by surgical route, and the minimally invasive route shortened hospital stays. Whether those pregnancies were caused by the surgery, and whether one approach ultimately delivers better reproductive results, remain open questions that the authors say require further research.

Subject of Research: Surgical and reproductive outcomes of open versus minimally invasive myomectomy in a UK retrospective cohort

Article Title: Surgical and reproductive outcomes after myomectomy: a retrospective cohort study of open and minimally invasive approaches in a UK tertiary centre

Article References: Omura, M., Krishnan, M., Metwally, M., & Ola, B. (2026). Surgical and reproductive outcomes after myomectomy: a retrospective cohort study of open and minimally invasive approaches in a UK tertiary centre. Archives of Gynecology and Obstetrics. https://doi.org/10.1007/s00404-026-08585-y

Image Credits: AI Generated

DOI: 10.1007/s00404-026-08585-y

Keywords: myomectomy, uterine fibroids, subfertility, laparoscopic surgery, live birth, clinical pregnancy, retrospective cohort, length of stay, Sheffield Teaching Hospitals, surgical outcomes, Surgical, reproductive