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Despite the volume of available research, many aspects of ULs remain unresolved, making it a \u201cparadoxical disease\u201d where the increase in available scientific literature has not been matched by an increase in solid evidence for clinical management. Fertility stands at the top of the list of clinical issues where the role of ULs is still unclear. The leiomyoma subclassification system, released by the International Federaion of Gynecology and Obstetrics (FIGO) in 2008, introduced a new and more effective way of categorizing uterine fibroids. The aim was to go beyond the traditional classification \u201csubserosal, intramural and submucosal\u201d, facilitating a detailed examination of individual ULs impact on the female reproductive system. The \u201ctype 3 UL\u201d is a special type of myoma, characterized by its complete myometrial development while encroaching the endometrium. It is a unique \u201chybrid\u201d between a submucous and an intramural UL, that may exert a detrimental \u201cdouble hit\u201d mechanism, which is of particular interest in patients wishing pregnancy. To date, no robust evidence is available regarding the management of type 3 ULs. The aim of this narrative review is to provide a comprehensive overview of the physiopathological mechanisms that type 3 UL may exert on fertility, and to present new perspectives that may help us to better understand both the need for and the methods of treating this unique type of fibroid.<\/jats:p>","DOI":"10.1002\/ijgo.15260","type":"journal-article","created":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T19:29:41Z","timestamp":1701113381000},"page":"975-987","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["The challenge of\n                    <scp>FIGO<\/scp>\n                    type 3 leiomyomas and infertility: Exploring therapeutic alternatives amidst limited scientific certainties"],"prefix":"10.1002","volume":"165","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1556-0962","authenticated-orcid":false,"given":"Alessandro","family":"Favilli","sequence":"first","affiliation":[{"name":"Section of Obstetrics and Gynecology, Department of Medicine and Surgery University of Perugia  Perugia Italy"},{"name":"Center of Perinatal and Reproductive Medicine University of Perugia  Perugia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Mazzon","sequence":"additional","affiliation":[{"name":"Arbor Vitae Endoscopic Centre  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Etrusco","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) University of Palermo  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Dellino","sequence":"additional","affiliation":[{"name":"1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM) University of Bari  Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Simone","family":"Lagan\u00e0","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) University of Palermo  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Tinelli","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, CERICSAL (CEntro di RIcerca Clinico SALentino) Veris delli Ponti Hospital  Scorrano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vito","family":"Chiantera","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) University of Palermo  Palermo Italy"},{"name":"Unit of Gynecologic Oncology National Cancer Institute \u2010 IRCCS \u2010 Fondazione \u201cG. 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