Myomectomy
A myomectomy is an operation to remove fibroids, the firm benign growths of uterine muscle, while keeping the uterus. Depending on where the fibroids are, it is done from inside through the cervix, by keyhole or robotic surgery, or through an open cut along the bikini line.
For fertility, location matters far more than size. A fibroid bulging into the cavity, where an embryo has to implant, lowers the chance of pregnancy and raises the chance of miscarriage. Removing it is one of the more reliable gains in fertility surgery. A fibroid on the outer surface of the uterus usually affects nothing, however large it looks on a scan.
So the question to settle first is where your fibroids sit, not how many there are. That answer decides whether surgery helps, which operation fits, how long you wait before trying, and how your baby is likely to be born. It is also the question that turns a worrying word on a scan report into a clear plan.
At a glance
- Also known as
- Fibroid removal, hysteroscopic myomectomy, laparoscopic myomectomy, robotic myomectomy, open myomectomy, abdominal myomectomy
- Appointment time
- 30–60 minutes hysteroscopic; 2–4 hours keyhole or open
- Anaesthesia
- General, or sedation for small hysteroscopic removals
- Time in clinic
- Day case hysteroscopic; 1–2 nights keyhole; 2–4 nights open
- Back to normal
- 1–3 days hysteroscopic; 2–3 weeks keyhole; 4–6 weeks open
- Whole process
- 1–2 weeks hysteroscopic; 6–8 weeks after keyhole or open surgery
- Scar
- None after hysteroscopic removal; small keyhole cuts or a bikini-line incision otherwise
- Typical cost
- $5,000–$30,000 (United States, self-pay)
- Usually preceded by
- Hysteroscopy
Figures reviewed .
On this page
Who it’s for
The clearest candidates have a submucosal fibroid, one that sits wholly or partly inside the cavity. Most fertility specialists recommend removing these before IVF or before trying naturally. Removal is also sensible for a fibroid in the wall that visibly distorts the cavity on a scan.
Intramural fibroids that sit within the wall without touching the cavity are decided case by case. Large ones may lower IVF success a little, and a good surgeon weighs that against the operation and the months of waiting that follow.
Subserosal fibroids, growing on the outside, rarely need removing for fertility. The reasons to operate there are symptoms, such as pressure, pain or a size that is crowding the pelvis.
Most clinics want a recent ultrasound or MRI that maps every fibroid, a blood count if periods are heavy, and smoking stopped. See eligibility.
Before you agree to surgery
Ask to see the scan image and have the surgeon point to each fibroid and say where it sits in relation to the cavity. Understanding the map yourself makes every later conversation clearer.
How it’s done
Hysteroscopic myomectomy is for fibroids inside the cavity. A slim telescope passes through the cervix, the uterus is filled with fluid, and the fibroid is shaved away in slivers with a small loop or a morcellator. There are no cuts on the abdomen at all. A large submucosal fibroid sometimes needs two sessions. See hysteroscopy for the procedure itself.
Laparoscopic and robotic myomectomy reach fibroids in the wall or on the surface. The surgeon cuts into the uterine muscle over each one, shells it out, then stitches the muscle back in layers. That repair is the part that matters most for a future pregnancy. The fibroid is removed through a small cut, often in a contained bag.
Open myomectomy, through a bikini-line incision, is used for very large or numerous fibroids, or where careful hand stitching of a deep defect is the safer choice. It means a longer recovery, but it is still a uterus-sparing operation.
At the consultation
Ask whether the cavity will be entered during the operation and how the wall will be repaired. The answers shape your waiting time and your birth plan, so you want them before the day.
After myomectomy
After hysteroscopic removal you go home the same day with period-like cramps and some bleeding for a week or two. Most people are back at work within a couple of days.
Keyhole and robotic surgery mean a night or two in hospital, sore small wounds, the same shoulder-tip pain from the gas as any laparoscopy, and two or three weeks before a desk feels manageable. After open surgery the wound is the main event. Expect four to six weeks off, no lifting, and tiredness that lingers.
Then comes the wait. After surgery on the uterine wall you will be asked to avoid pregnancy for a while so the scar can heal fully, commonly around three to six months.
| Weeks before | Scan or MRI to map the fibroids. Sometimes iron or a short course of hormone treatment to shrink them and settle bleeding. |
|---|---|
| Day 0 | Surgery. Home the same day after a hysteroscopic removal; one to four nights after keyhole or open surgery. |
| Week 1 | Cramping and bleeding settle after a hysteroscopic removal. Wounds sore and walking slowly after abdominal surgery. |
| Weeks 2–6 | Back to a desk after keyhole surgery, then after open surgery towards the end of this window. |
| Months 1–2 | A follow-up scan or hysteroscopy to check the cavity, especially after a large submucosal fibroid. |
| Months 3–6 | The usual window when trying to conceive or an embryo transfer can start after surgery on the wall. |
In the first month
Write down the date your surgeon says you can start trying, and the method of birth they advised. Having both in writing saves confusion when you see a different doctor later in pregnancy.
Myomectomy scars
Hysteroscopic removal leaves no scar you can see. Keyhole and robotic surgery leave three to five small cuts, each about a centimetre, one usually in the navel. Open surgery leaves a horizontal bikini-line scar, much like a caesarean, that fades to a fine line over a year.
The scar that matters most is the one inside the uterine wall, and it is covered under risks.
Risks and complications
Bleeding is the main early risk, because fibroids have a rich blood supply. A transfusion is occasionally needed after large or multiple removals, and surgeons use medication and careful technique to keep blood loss down. Infection and the usual anaesthetic risks apply.
Inside the cavity, scar tissue can form after hysteroscopic removal, especially if two fibroids faced each other. A check hysteroscopy afterwards picks this up.
The specific risk for a future pregnancy is the scar in the uterine wall. When a deep fibroid has been removed, many surgeons recommend a planned caesarean, so the uterus does not have to labour against that repair. Rupture is rare but serious, which is why that advice is firm.
Fibroids can grow back. New ones appear over the years in a sizeable share of women.
Myomectomy results
Removing a submucosal fibroid is one of the clearer wins in fertility surgery. Pregnancy rates afterwards move towards those of women without fibroids, and the raised miscarriage risk falls back.
For fibroids in the wall, the benefit grows with size and with how close they sit to the cavity. For subserosal fibroids, removal mainly helps symptoms. Heavy bleeding, pressure and pain usually improve a great deal after any successful myomectomy.
What tends to disappoint is the wait, and the advice about birth. I have watched many patients feel ready to move on straight after surgery, only to hear about the waiting period for the first time at discharge. Knowing it in advance turns that into a plan.
Alternatives to myomectomy
If your fibroids sit outside the cavity and are not causing symptoms, the best alternative is often to leave them and go ahead with treatment. That saves months.
Hormonal treatment can shrink fibroids and control bleeding for a while, but they regrow when it stops, and most types stop you conceiving while you take them. Uterine artery embolisation and focused ultrasound shrink fibroids without surgery, but they are generally not first choice for women planning a pregnancy.
If age or ovarian reserve is pressing, it can make sense to freeze embryos before a myomectomy, then transfer once the uterus has healed.
Hysteroscopy
A hysteroscopy passes a fine camera through the cervix to look inside the uterus and, in the same sitting, remove polyps, small fibroids, a septum or scar tissue. Its value for fertility comes from what it finds and treats in the cavity.
Best for: people with a polyp, fibroid, septum or scarring seen or suspected inside the uterus, before IVF or after transfers that did not implant
IVF
Conventional IVF, where the ovaries are stimulated to produce a batch of eggs, the eggs are collected under sedation and mixed with sperm in the laboratory, and one embryo is transferred. The core treatment that the other pages in this group are variations on.
Best for: anyone whose tubes, sperm or time make natural conception unlikely, and who wants the treatment with the best odds per attempt
Combining myomectomy with other treatment
A myomectomy is often planned around IVF rather than instead of it. One common sequence is egg collection and embryo freezing first, then the myomectomy, then a frozen embryo transfer once the uterus has healed. That uses the waiting period well.
A laparoscopic myomectomy can be combined with a hysteroscopy, and sometimes with treatment of endometriosis, under one anaesthetic.
Myomectomy cost
The operation type drives the price. A hysteroscopic removal is a short day case. Robotic surgery adds the cost of the robot. An open myomectomy carries several nights in hospital.
Ask whether the quote is all-in, including surgeon, anaesthetist, theatre, nights in hospital and histology, and what happens if a transfusion or an extra night is needed. Ask about the cost of the follow-up hysteroscopy, which is easy to miss.
Bangkok's private hospitals are a strong destination for myomectomy. Packages are typically a fraction of US self-pay prices, and robotic surgery is widely available. Allow for the longer stay after abdominal surgery before flying.
| Country | Self-pay | Public / insurance |
|---|---|---|
| United States Hysteroscopic removal at the bottom; robotic or open removal of multiple fibroids at the top | $5,000–$30,000 | Commonly covered for symptoms such as heavy bleeding; fertility-only indications vary by plan |
| United Kingdom Private packages usually include the hospital stay | £2,500–£15,000 | Available on the NHS where fibroids cause symptoms or distort the cavity; waits vary |
| Thailand Packages at private Bangkok hospitals; robotic surgery costs more than conventional keyhole | $2,000–$12,000 | Self-pay for international patients |
Read more: Fertility Surgery
Choosing a clinic for myomectomy
The surgeon's skill matters most in the repair of the uterine wall, because that scar carries a future pregnancy. You want a gynaecologist who does myomectomies regularly, by the route your fibroids need.
Ask how many myomectomies they do a year, and what proportion they complete by keyhole or robot rather than converting to open surgery. Ask how they close the uterine wall and in how many layers.
The question that reveals the most is what they will advise about birth afterwards. A surgeon who answers clearly about caesarean and waiting time has a plan for your pregnancy as well as your fibroids. I would want to hear that before the date is booked.
When you consent
Ask the surgeon to note on your discharge letter whether the cavity was entered and how deep the wall repair went. A future obstetrician will need that detail to plan your birth safely.
Frequently asked questions
Do all fibroids affect fertility?
No. Those inside or distorting the cavity do; those on the outer surface rarely do. See who it's for.
How long do I wait before trying to conceive?
Days to weeks after a hysteroscopic removal, and commonly three to six months after surgery on the wall. See afterwards.
Will I need a caesarean?
Often, if a deep fibroid was removed from the wall. Your surgeon will advise based on the repair. See risks.
Can fibroids come back?
Yes. New fibroids can grow over the years, which is one reason not to delay trying for long after surgery.