Fibroids and Infertility
Fibroids are benign tumors, which start in the muscle wall of the uterus. They are extremely common and up to 30% of women may develop fibroids at some time in their lives.
It is extremely rare for them to become malignant tumors that might jeopardize the woman’s life. However, these may affect the woman’s health in other ways. Fibroids sometimes may cause abnormal and heavy vaginal bleeding or heavy menstrual periods. They may also reach a significant size and cause pain or discomfort symptoms at pressing other female pelvic organs such as the bladder or intestine. Finally, fibroids may affect the uterus in such a way that they may interfere with the normal reproductive process and the normal course of pregnancy.
Several aspects of fibroids determine if they can decrease the likelihood for a woman to achieve pregnancy and to carry pregnancy to term successfully. The location of fibroids is the most relevant aspect. Fibroids may grow from the wall of the uterus outwards (subserosal), in the thickness of the uterine wall (intramural) or from the wall of the uterus inward of the uterine cavity (submucosal.) There is enough medical evidence to say that subserosal fibroids DO NOT decrease the likelihood of pregnancy naturally, nor affect the development of pregnancy. On the other hand, it is also clear that submucosal fibroids decrease the chance to become pregnant and increase the risk of having a miscarriage (spontaneous abortion.) Controversy exists over whether intramural fibroids affect a woman’s fertile potential and the development of pregnancy. It seems that this only happens when the fibroids reach a large size (larger than 5 cm) or when they are multiple.
There are several ways to study the existence of fibroids in a woman’s uterus. The initial approach is the transvaginal pelvic ultrasound based on the ultrasound images. It allows detecting the presence and size of fibroids. Despite being a simple and extremely useful test, it often requires to be complemented with other tests, to determine the location of fibroids and condition of the uterine cavity. They include the sonohysterography, which is a transvaginal pelvic ultrasound with the injection of fluid into the uterine cavity and hysteroscopy, the insertion of a small lens into the uterine cavity that allows viewing the inside through a video screen.
If it is determined that the fibroids are affecting the likelihood and/or prognosis of pregnancy, they may be removed through a minimally invasive and outpatient surgery. These surgical techniques with minimal incisions are known as laparoscopy or hysteroscopy. The laparoscopy is based on the insertion of a lens into the abdomen through a small incision of 1 cm in the navel and some instruments or graspers through minimal incisions (0.5 cm) in the lower abdomen. This is used to remove subserosal or intramural fibroids. Hysteroscopy allows the removal of the submucosal fibroids entering through the vagina into the uterus.
Generally, most of women with uterine fibroids do not show any symptoms and do not require any type of treatment for women who have difficulty to get pregnant with large submucosal or intramural fibroids; the surgical treatment is simple, minimally invasive and successful.
Dr. Juan Luis Giraldo