How long should I wait after a myomectomy to attempt pregnancy?

From the Guidelines

You should wait at least 2-3 months after a myomectomy before attempting pregnancy to allow the uterine incisions to heal and minimize the potential for myometrial scar disruption during pregnancy. This recommendation is based on clinical experience with the classic Cesarean section scar, where the incision is located in the contractile portion of the uterus, as noted in the study by 1. The study highlights the importance of allowing the uterine incisions to heal to prevent complications such as uterine rupture during pregnancy.

The healing process involves the formation of strong scar tissue in the uterus, which needs adequate time to develop to withstand the stretching that occurs during pregnancy. Factors such as the type of myomectomy procedure, the extent of the surgery, and the presence of any complications can influence the recommended waiting period. For example, laparoscopic procedures might require less recovery time than open abdominal surgeries.

It is essential to use reliable contraception during the recovery period to prevent pregnancy and to schedule a follow-up appointment with your doctor to confirm proper healing and discuss any specific considerations for your situation. Some doctors may recommend additional tests, such as a hysterosalpingogram (HSG) or hysteroscopy, to evaluate the uterine cavity before attempting pregnancy, as mentioned in the study by 1.

Key considerations for attempting pregnancy after a myomectomy include:

• Allowing the uterine incisions to heal to minimize the risk of complications
• Using reliable contraception during the recovery period
• Scheduling a follow-up appointment with your doctor to confirm proper healing
• Discussing specific considerations for your situation, such as the type of myomectomy procedure and the presence of any complications
• Considering additional tests, such as a hysterosalpingogram (HSG) or hysteroscopy, to evaluate the uterine cavity before attempting pregnancy, as noted in the study by 1.

From the Research

Waiting Period After Myomectomy

The waiting period after a myomectomy before attempting pregnancy is a crucial consideration for women who wish to conceive.

• According to a study published in 2015 2, patients were advised to try for pregnancy after 16 weeks of operation.
• However, a systematic review published in 2021 3 found that the mean time between myomectomy and pregnancy was estimated at 17.6 months, and there is no linear relationship between gestational age at the event and time interval from myomectomy to conception.
• Another study published in 2017 4 stated that there is no consensus on the optimal interval between myomectomy and conception, and pregnancy in patients with fibroids or previous myomectomy should be considered as high risk.

Factors Influencing the Waiting Period

Several factors can influence the waiting period after myomectomy, including:

• The size and location of the fibroids removed during the procedure
• The type of myomectomy performed (e.g., abdominal, laparoscopic, or robotic)
• The individual's overall health and fertility status
• A study published in 2019 5 recommended delivering the baby via Caesarean section after myomectomy, due to the fear of intrauterine rupture of the uterus.
• Another study published in 2002 6 found that myomectomy during pregnancy can be performed if necessary, and cesarean section was performed on all patients at 37-40 weeks.

Pregnancy Outcomes After Myomectomy

Pregnancy outcomes after myomectomy can vary depending on several factors, including:

• The study published in 2015 2 found that 14 (35%) women conceived after myomectomy, and 12 (85.7%) delivered live babies by LUCS.
• The systematic review published in 2021 3 found that among 3852 women who wanted to become pregnant after the surgery, 2889 became pregnant, accounting for 3000 pregnancies (77.9%) and 2097 live births (54.4%).