{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:40:41Z","timestamp":1791380441334,"version":"4.3.3"},"reference-count":21,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T00:00:00Z","timestamp":1749513600000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Obstet and Gynaecol"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>The aim of this study was to evaluate the surgical, reproductive, and perinatal outcomes of patients with diffuse uterine leiomyomatosis desiring fertility preservation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients diagnosed with diffuse uterine leiomyomatosis based on magnetic resonance imaging at Kindai University Hospital between 2017 and 2024 were included in a case series. A systematic literature review on diffuse uterine leiomyomatosis desiring fertility preservation was carried out.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The case series showed that fertility preservation was desired in 8 of 18 cases, of which 1 was conceived after assisted reproductive technology and underwent cesarean section at 34\u2009weeks of gestation for placenta previa accreta. A systematic literature review identified 31 cases from descriptive observational studies (1\u20138 cases per study). Although more fibroids (<jats:italic>n<\/jats:italic>\u2009=\u200987) were enucleated by extensive myomectomy than by hysteroscopic myomectomy (<jats:italic>n<\/jats:italic>\u2009=\u200933) (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001), extensive myomectomy was often associated with massive blood loss and blood transfusion. Perinatal complications were more frequent in extensive myomectomy (5\/7) compared to hysteroscopic myomectomy (2\/12, <jats:italic>p<\/jats:italic>\u2009=\u20090.04). Preterm delivery before 36\u2009weeks was more frequent in extensive myomectomy (4\/6 cases) than in hysteroscopic myomectomy (1\/11 cases, <jats:italic>p<\/jats:italic>\u2009=\u20090.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Fertility preservation in diffuse uterine leiomyomatosis was previously considered difficult, but it is now recognized to be possible. Hysteroscopic myomectomy is a minimally invasive option. If conception is not achieved, extensive myomectomy may be considered. However, extensive myomectomy is more invasive, with a higher risk of perinatal complications. Large\u2010scale clinical trials are required to establish a management standard for diffuse uterine leiomyomatosis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jog.16332","type":"journal-article","created":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T19:40:32Z","timestamp":1749584432000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Management of diffuse uterine leiomyomatosis for fertility preservation: Case series and systematic literature review"],"prefix":"10.1111","volume":"51","author":[{"given":"Kiko","family":"Yamamoto","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Kindai University Faculty of Medicine  Osaka\u2010Sayama Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2108-9812","authenticated-orcid":false,"given":"Kaoru","family":"Kawasaki","sequence":"additional","affiliation":[{"name":"Department of 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