Fibroids and Fertility
Can fibroids affect chances of getting pregnant?
Fortunately, fibroids do not usually interfere with fertility. Most of the fibroids are small and do not interfere with the cavity of the uterus or the fallopian tubes.
Submucous fibroids (those which encroach on the uterine cavity) can sometimes affect the process of implantation. This can lead to sub-fertility and sometimes early pregnancy loss.
Fibroids in the upper corner of the uterus (cornual region) can occasionally obstruct fallopian tubes and can be a cause of tubal factor subfertility. Similarly, very large fibroids and an enlarged uterine cavity can be a cause of not getting pregnant.
So in general, if the fibroids are small (smaller than 6cm) AND if the cavity is normal AND if the fallopian tubes are patent (open), there is no cause to worry.
What investigations can be carried out to ensure fertility is not affected?
An ultrasound scan can help in assessment of size, numbers and location of fibroids in relation to the uterine cavity and fallopian tubes.
Hycosy (HYstero-Salpingo COntrast SonographY) scan is where a contrast in injected into the uterine cavity and visualised on scan coming out of the fallopian tubes. This helps in more accurate assessment of uterine cavity and tubal patency.
Hysteroscopy is direct visualisation of uterine cavity with an endoscope. This is a gold-standard for assessment and treatment of submucous fibroids to normalise the uterine cavity. This procedure is called as TransCervical Resection of Fibroid (TCRF) or Hysteroscopic Myomectomy.
Laparoscopy can help in assessment of the fibroids in relation to the fallopian tubes and also feasibility for laparoscopic surgery.
What can be done to treat these fibroids?
Fibroids do not usually need to be removed unless in above circumstances. If surgery is needed, the best outcomes are associated with minimally invasive or endoscopic surgery.
Submucous fibroids can be removed by hysteroscopic myomectomy. This is a simple day surgery procedure which is performed through natural passage of the cervix and no cuts are required.
Larger fibroids can often be removed through laparoscopic myomectomy and rarely an open procedure may be required.
Is pregnancy outcome better after a myomectomy?
There is some evidence that Myomectomy is associated with improved pregnancy and fertility outcome. This is dependent on various factors such as previous history, location and size of fibroids.