Removal of myomas in asymptomatic patients to improve fertility and/or reduce miscarriage rate: a guideline

•There is insufficient evidence to conclude that myomas reduce the likelihood of achieving pregnancy with or without fertility treatment. (Grade C)•There is insufficient evidence to determine that a specific myoma size, number, or location (excluding submucosal myomas or intramural myomas impacting the endometrial cavity contour) is associated with a reduced likelihood of achieving pregnancy or an increased risk of early pregnancy loss. (Grade C)•There is insufficient evidence that removal of subserosal fibroids improves fertility. (Grade C)•There is fair evidence that myomectomy does not impair reproductive outcomes (clinical pregnancy rates, live-birth rates) following ART. (Grade B)•There is insufficient evidence that myomectomy (laparoscopic or open) reduces miscarriage rates. (Grade C)•There is fair evidence that hysteroscopic myomectomy for submucosal myomas improves clinical pregnancy rates. (Grade B)•There is insufficient evidence to conclude that hysteroscopic myomectomy reduces the likelihood of early pregnancy loss in women with infertility and a submucous fibroid. (Grade C)