Large Uterine Fibroids Before IVF?
Single-Port Laparoscopic Myomectomy Through the Belly Button

A woman over 40, struggling with infertility, placed her final hope in assisted reproduction — only to be blocked by two large uterine fibroids.

On one side: the urgency of advanced maternal age. On the other: the fear that these "uninvited guests" inside her uterus might threaten a future pregnancy. Over the past 3 years, the fibroids had steadily grown from 5cm to 7cm and 6cm, positioned on the anterior and posterior walls of the uterus — a pincer attack from front and back.

When the fibroids were first discovered 3 years ago, she had no notable symptoms: no increased menstrual bleeding, no anemia, rarely even dysmenorrhea. They seemed like "well-behaved" fibroids. But now, as she prepared to start IVF, she could no longer ignore them.

01 · The Dilemma for Women Over 40 Trying to Conceive

With these questions and anxiety, Ms. N came to see renowned gynecologist Professor Sun, seeking expert guidance.

In the consultation room, Professor Sun conducted a comprehensive evaluation based on her medical history, ultrasound, and gynecological examination. The MRI images revealed that besides the two large fibroids on the anterior and posterior walls, there were 3 smaller fibroids measuring 3cm, 2cm, and 1.5cm respectively — a total of 5 fibroids. To help Ms. N better understand, Professor Sun used a uterine model to carefully explain how fibroids in different locations can affect pregnancy and the gestational process.

MRI Image: The "squeezed" uterus — anterior and posterior fibroids forming a pincer attack

What Are Uterine Fibroids?

Uterine Fibroids (Leiomyomas) are benign tumors arising from the smooth muscle tissue of the uterus. They are the most common benign tumors in women. Based on their relationship to the uterine wall, they are classified as:

• Submucosal fibroids — protrude into the uterine cavity; greatest impact on pregnancy
• Intramural fibroids — located within the uterine muscle wall
• Subserosal fibroids — bulge outward from the uterus; less impact on the cavity

How Fibroids Affect Pregnancy

Ms. N's two larger fibroids were growing toward the serosa and bulging outward, with minimal impact on uterine cavity shape. Theoretically, most do not affect conception. However, both fibroids were over 5cm in diameter — the risks during pregnancy increase significantly:

• Under the influence of estrogen and progesterone, fibroids may grow rapidly
• First trimester: large fibroids may compress uterine blood vessels, affecting endometrial blood supply, leading to embryo hypoxia and miscarriage
• May trigger abnormal contractions, increasing miscarriage risk
• Second/third trimester: fibroid degeneration, acute abdominal pain
• Increased risk of miscarriage, preterm labor, difficult labor, postpartum hemorrhage

The unknown risks were too great. Ms. N decided immediately to have the two "roadblocks" surgically removed.

Why Single-Port Laparoscopy?

For women over 40 trying to conceive, the surgical goal is not only complete fibroid removal but also maximizing protection of the uterine muscle layer to provide a safe foundation for future pregnancy.

Professor Sun designed a "Transumbilical Single-Port Laparoscopic Myomectomy" for her:

• Only a ~2cm incision through the navel
• The navel is the body's "natural scar" — no subcutaneous fat or muscle tissue
• Post-operative scarring blends with the navel's natural folds, nearly invisible
• Preserves fertility while achieving excellent cosmetic results

"No laparotomy, just one small incision" — Ms. N finally breathed a sigh of relief.

02 · The "Scarless Challenge": Large Fibroids, Tiny Incision

Single-port laparoscopic surgery places high demands on the surgeon's skill: the instruments enter almost parallel through a single port, without the "triangular operating space" of traditional laparoscopy — like "dancing with shackles" in a confined space. Every step — from complete enucleation of multiple fibroids to layered suture of the uterine wound — tests the surgeon's experience and tactile skill.

Step-by-Step: The Surgery

1. General anesthesia administered; instruments inserted through the single umbilical incision
2. Comprehensive exploration of the uterus and pelvic cavity
3. Fibroids enucleated completey along their capsules (all 5 fibroids)
4. Uterine wound closed with continuous layered suture using barbed suture
5. Anti-adhesion barrier applied to the wound surface
6. The two large fibroids extracted through the umbilical incision using a "apple-peeling" morcellation technique

The entire surgery was completed successfully in 2 hours and 3 minutes. Ms. N's vital signs remained stable throughout, and she returned to the ward in good condition. Under the ERAS protocol with optimized pain management, refined nursing, and dietary guidance:

• Day of surgery: able to turn in bed
• Next day: able to get out of bed and walk
• The tiny incision in the navel was "perfectly" hidden — almost no visible surgical scar

After a period of recovery, Ms. N can resume her journey toward pregnancy!

03 · Fibroids and Pregnancy: Don't Panic — Here's What to Do

Discovering uterine fibroids while planning pregnancy is a common dilemma for many women: Should I have surgery first? How do I choose the surgical approach? These questions often cause significant anxiety.

✅ You Can Try to Conceive Directly If:

• Fibroids are small (typically under 4cm)
• Location does not distort the uterine cavity (e.g., subserosal fibroids)
• No related symptoms (normal periods, no pain)

→ Monitor fibroid size and growth during pregnancy with regular ultrasounds.

🔬 Consider Surgery Before Pregnancy If:

• ● Submucosal fibroids: protrude into the cavity and affect the endometrium — regardless of size, may cause infertility or increase miscarriage risk
• ● Large intramural fibroids: distort the cavity or endometrium, increasing infertility and miscarriage risk; or compress the fallopian tube ostia
• ● Cervical fibroids: grow into the cervical canal and may obstruct sperm passage
• ● Symptomatic fibroids: cause heavy periods, anemia, pelvic pain, or pressure symptoms (urinary frequency, constipation)