Is ‘cold loop’ hysteroscopic myomectomy a better option for reproduction in women with diffuse uterine leiomyomatosis? A case report of successful repeated pregnancies Ivano Mazzon 1 , Alessandro Favilli 2 , Mario Grasso 1 , Daniela Morricone 1 , Gian Carlo Di Renzo 2 and Sandro Gerli 2 1 ‘Arbor Vitae’ Centre, Clinica Nuova Villa Claudia, Rome, and 2 Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy Abstract Diffuse uterine leiomyomatosis (DUL) is a rare clinical entity with important reproductive consequences. To date, only four pregnancies have been reported after hysteroscopic myomectomy. Here we describe the case of a 28-year-old infertile woman with diffuse uterine leiomyomatosis, who presented infertility and metrorrhagia lasting for 2 years. A countless number of subserous, intramural and submucous myomas were ultrasonographically revealed. Diagnostic hysteroscopy described a uterine cavity completely subverted by the presence of myomas. A two-step ‘cold loop’ hysteroscopic myomectomy was performed following the tech- nique previously described. One month after the treatment, there were no submucous myomas. A regular uterine cavity free of synechiae was endoscopically confirmed.After the treatment, the patient carried to term three consecutive, uneventful pregnancies. This is the first report of repeated successful pregnancies following the ‘cold loop’ hysteroscopic technique in DUL. We believe that ‘cold loop’ resectoscopic myomectomy may provide new advantageous perspectives for women with DUL seeking pregnancy. Key words: cesarean section, cold loop myomectomy, diffuse uterine leiomyomatosis, fertility, hysteroscopic myomectomy. Introduction Diffuse uterine leiomyomatosis (DUL) is a rare patho- logical condition characterized by the presence of innumerable myomas in the context of myomet- rium. In extreme cases, it is very difficult to identify intact areas of healthy tissue where there are no myomas. 1–4 Hysterectomy is the most frequently used surgical procedure for its treatment regardless of age as the condition is the cause of severe menometrorrhagia. 5 Infertility is often present and the management of this condition is complex for patients who wish to have children. Considering the number of myomas to be removed, traditional myomectomy may be non- resolutive and damaging to healthy myometrial tissue in these patients, with a possible risk of severe compli- cations during subsequent pregnancies. 6 Several authors have recently proposed hystero- scopic myomectomy as a treatment for DUL, in the presence of submucous myomas, reporting excellent reproductive outcomes. Four pregnancies have been Received: February 18 2014. Accepted: July 27 2014. Reprint request to: Dr Sandro Gerli, Department of Obstetrics and Gynecology, University of Perugia, Ospedale S.M. della Misericordia, 06156 Perugia, Italy. Email: sandro.gerli@unipg.it doi:10.1111/jog.12548 J. Obstet. Gynaecol. Res. Vol. 41, No. : – , 2015 3 474 477 March © 2014 The Authors Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology 474