[Management of uterine myomas in women of fertile age].

Objective: Review of current knowledge about uterine fibroids management in young women. Analysis of possible diagnostic and therapeutic algorithms regarding fertility preserving.
Design: Review article.
Setting: Department of Obstetrics and Gynecology, 1st Faculty of Medicine and the General Faculty Hospital, Charles University, Prague.
Methods: Analysis of the facts in literature (texts in medical journals, monographies, textbooks, internet database Medline and Ovid) and authors' clinical experience.
Conclusions: Alternatives of treatment of infertility in women with uterine fibroids have significantly enlarged in past 10 years. However none of the indicated methods is perfect. Expectation does not exclude the risk of growth of fibroids and abortion. The effect of pharmacological therapy is only temporary. Myomectomy is associated with the risk of surgical complications, fibroids' recurrence and uterine rupture in subsequent gestation. Although uterine artery embolisation (on an average) halves the fibroids volume, the long-term effect of the method on female fertility is still unknown. Nevertheless it seems convenient to advise the active approach to all women planning pregnancy and having significant (submucous or intramural) fibroid even before spontaneous or assisted conception. Most recent studies indicate significant improvement of reproduction outcomes after myomectomy, especially in young women with the absence of other factors of infertility. Only the results of randomized, controlled trials (that are still awaited) will inform us about comparison of the effects and risks of myomectomy and uterine artery embolization in management of infertility.