Should you have your fibroid removed to get pregnant??
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 determine the locality 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 effect the chance for a healthy pregnancy .
There are different types depending on the location .If they are small, situated on the outer lining and growing outside (subserous fibroids), generally they don't affect the 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 due to alteration in the anatomy, even if they located on outer lining , 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 not affect if they are less than 2 cm, but larger ones may affect chances of getting pregnant .
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 , so it will cause infertility or subfertility .Even a tiny fibroid of .5 cm can be bad news if it is submucous (inside the uterus).These kind of fibroids need to be removed by endoscopic surgery and it is done by hysteroscopic myomectomy .
If the fibroids are producing 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 stop ovulation in the women , so this may not be the right treatment for subfertility .The only indication would be to give them prior to surgery .
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.
We see many patients coming for surrogacy with history of failed IVF and failed surgery , as the fibroids tend to reoccur after removal .
Surrogacy is a good option for women with multiple large fibroids where hysterectomy is needed , or in cases of recurring fibroids .
Dr.Anita Mani
Infertility& Surrogacy Specialist at Gift IVF Centre
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