You are here
Are Fibroids and Polyps Preventing You from Getting Pregnant?
a blog by David Kreiner, M.D., F.A.C.O.G.
Fertility is dependent upon so many things!
First it must involve healthy gametes (eggs) capable of fertilizing and implanting in a uterus with a normal endometrial lining unimpeded by any uterine or endometrial pathology. Then, it requires sperm (in sufficient number) that are capable of swimming up through a cervix which is not inflamed and provides a mucous medium that promotes sperm motility. The eggs need to ovulate and be picked up by normal healthy fimbriated ends (finger like projections) of the fallopian tubes. The tubes need to be covered with normal micro hairs called cilia that help transport the egg one third of the way down the tube where one of the sperm will fertilize it.
The united egg and sperm (the “conceptus”) then needs to undergo cell division, growth and development as it traverses the tube and makes its way to the uterine cavity by the embryo’s fifth day of life at which point it is a blastocyst. The blastocyst hatches out of its shell (“zona pellucidum”) and implants into the endometrial lining requiring adequate blood flow.
And you wonder why getting pregnant is so hard?
Now, on top of all that, occasionally, an intramural myoma (fibroid in the uterine muscle wall) may obstruct adequate blood flow to the endometrial lining. However, it is the submucosal myoma, inside the uterine cavity, that produces an IUD-like effect of irritating the uterine lining which can prevent implantation. Endometrial polyps (endometrial tissue protruding into the uterine cavity) may have a similar effect.
If your pregnancy is being hindered by these growths, you may need to have a hydrosonogram. A hydrosonogram is a procedure where your doctor or a radiologist injects water through your cervix into your uterus while performing a transvaginal ultrasound of your uterus. On the ultrasound, the water shows up as black against a white endometrial border. A defect in the smooth edges of the uterine cavity caused by an endometrial polyp or fibroid may be easily seen.
The hydrosonogram is performed by placing a thin tubular plastic catheter through the cervix into the uterine cavity. Water is injected using a syringe connected to a plastic tube. A patient may feel mild cramping, which is occasionally worse when she has fallopian tube disease or obstruction. Sometimes, at this point, a doctor will also use an embryo transfer catheter and perform an embryo transfer trial in anticipation of an in vitro fertilization (IVF) cycle.
Both polyps and fibroids in the uterine cavity can cause abnormal vaginal bleeding and occasionally cramping. These polyps and fibroids are almost always benign but they may need to be removed to render implantation. An endometrial polyp may be removed by a hysteroscopy, dilatation and curettage procedure. A hysteroscopy is performed vaginally, while a patient is asleep under anesthesia. A scope is placed through the cervix into the uterus in order to look inside the uterine cavity. This procedure can often be performed as an outpatient in an ambulatory or office based surgery unit. The risk of bleeding, infection or injury to the uterus is extremely rare.
Resection of a submucosal myoma is more difficult and is a longer procedure than the polypectomy. It too is performed hysteroscopically, without cutting. Sometimes, especially when the fibroid is large, it will take multiple procedures in order to remove the fibroid in its entirety. It will be necessary to repeat the hydrosonogram after the fibroid resection to make sure the cavity is satisfactory for implantation.
Are polyps or fibroids preventing you from getting pregnant?
Though the procedures I’ve described above are no picnic, failure to do them to remove endometrial polyps and submucosal myomata will not only prevent your pregnancy from occurring spontaneously, it will prevent implantation even with IVF!