Fibroids are just benign tumors of the uterus and around 30
% of women develop fibroids as they enter their thirties.
The relation between fibroids and fertility is often confusing to
the patients. The clinician has to find out the location and size of fibroid to
ascertain, if it can cause any negative effect on pregnancy. The fibroids can
be left alone if they are small and do not affect the chance for a healthy
pregnancy.
There are different types of fibroids depending on the location.
If they are small, situated on the outer lining and growing outside the uterus
(subserous fibroids), generally they do not hinder conception,
unless they are very close to the area of the opening of the tubes.
Big sized fibroids (more than 5 cm) may have negative effect on
pregnancy, even if they are located on outer lining due to the alteration in
the anatomy, as the sheer weight might change position of uterus, thus reducing
chance of egg pickup by the fallopian tubes.
If the fibroids are small and situated in the myometrium,
inside of muscle mass of the uterus (intramural fibroids), they may be
harmless if they are less than 2 cm, but larger ones may reduce chances of
pregnancy.
Laparoscopic myomectomy ( removal of fibroids) is a good option to
remove subserous fibroids and the intramural fibroids.
Most of the fibroids which grow near the inner lining and
bulge into the uterine cavity distort the cavity where the baby has
to grow leading to infertility or subfertility. Even a tiny fibroid of .5 cm
can be bad news, if it is submucous (inside the uterus). These kinds of
fibroids need to be removed by endoscopic surgery and it can be done by hysteroscopic
myomectomy.
If the fibroids are causing symptoms due to compression on nearby
structures like bladder and ureter, then they have to be removed.
Although there are injections to shrink fibroids, the results are
temporary and stops ovulation in the woman, so this may not be the right
treatment for subfertility. The only indication would be to give them prior to
surgery.
Even after considering all these factors, the treatment cannot be
generalised, as it will be different for different individuals.
To make a decision, the clinician has to personally do a detailed
transvaginal scan to assess whether to go for a surgery or not.
It needs to be kept in mind that surgery does have a very
small risk of hysterectomy (removal of uterus) in case of bleeding. Heavy
bleeding during the procedure is a potential risk, especially in complicated
cases, wherein any surgeon would opt to remove the uterus to save the patient's
life.
for more details you can visit the following blogs
Dr.
Anita Mani
Infertility Specialist at Gift IVF Centre
Infertility Specialist at Gift IVF Centre
anitadane@gmail.com
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Dr. Anita Mani is a renowned infertility specialist in
south India with 15 years experience in ART (Assisted Reproductive Technology).
Dr. Anita has successfully set up ART hospitals in Cochin and Bangalore,
along with her spouse Dr. S Mani. She
completed MRCOG, from Royal College of Obstetrician and Gynaecologist London, DFFP from ART Warwick university and worked
in UK for 5 years. Dr. Anitha believes in scientific and ethical practice and
is currently the director of Gift Gyno IVF centre Cochin
and Bangalore. Apart from advanced laparoscopic
surgeries, she is also an expert in various ART techniques including IVF,
IUI, ICSI , donor egg / sperm. Her proficiency is in
genetic abnormalities and high risk pregnancies.
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