Case report of the management of intravascular leiomyomatosis including uterine surgery, vascular surgery, hormonal management, and in vitro fertilization.

Intravascular leiomyomatosis (IVL) is a rare smooth muscle tumor extending into uterine veins and beyond, usually treated with hysterectomy. We present a 33-year-old Gravida (G) 2 Para (P) 0 patient with suspected uterine sarcoma on imaging, later diagnosed intraoperatively with IVL during abdominal myomectomy. Postoperatively, pulmonary embolism required thrombectomy, followed by long-term gonadotropin-releasing hormone (GnRH) agonist therapy that reduced tumor burden until open vascular resection of the inferior vena cava was completed. Two embryo banking cycles with preimplantation genetic testing for aneuploidy were performed, leading to autologous transfer of a euploid embryo and live birth, complicated by placenta accreta requiring cesarean hysterectomy. Fertility preservation with multimodal IVL management is feasible.