Up to the present day, the problem of improving outcomes of surgical treatment of atypical uterine myomas in young patients planning pregnancy is challenging. The article describes this problem on the basis of the analysis of the published works and own results of the researches of the authors. There are demonstrated typical clinical manifestations of atypical uterine myomas of large sizes with functional impairment of neighboring organs, necessity of thorough preoperative preparation with the identification of peculiarities of tumor localizations, detailed description of topography of lumps, when a combination of abdominal and vaginal ultrasonic scanning is of great importance. There are presented peculiar features of ultrasonic visualization of cervical and isthmic uterine myomas, criteria of ultrasonic assessment of the scar condition on the uterus in the early postoperative period and 6 months after the surgery. It is underlined that organ preserving surgery is optimal for young patients with large-sized atypical uterine myoma, who plan pregnancy; the only contraindication is a sarcoma detected by histologic express diagnostics. There are described peculiar features of surgical interventions in dependence with the topography of atypical uterine myoma and postoperative rehabilitation. The authors present their results demonstrating that in the period from 2014 to 2017, totally 297 young patients planning pregnancy underwent organ preserving uterine myomectomy surgeries. Pregnancy occurred in 206 (69.4%) patients, 143 patients (69.4%) gave birth in full-term pregnancy. The advanced diagnostics, surgical techniques, and postoperative rehabilitation in atypical uterine myomas of large and gigantic sizes in young patients have made it possible to reduce the frequency of histerectomia from 50.8 to 1% and to increase fertility of the patients up to 69.4%.