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Are Fibroids Contributing to Your Infertility?
a blog by David Kreiner, M.D., F.A.C.O.G., Apr. 20, 2010
Fertility is dependent upon so many things! Even with all systems go, getting pregnant – even without assisted reproductive technology -- can be seen as a biological miracle. But all too often, patients (in some groups as many as 30 percent of women), are told that they have fibroids that may be contributing to their infertility.
Fibroids or leiomyomata are non malignant smooth muscle tumors of the uterus. They can vary in number and size. And they can grow in different locations around the uterus including: on the outside facing the pelvic cavity (subserosal); on the inside facing the uterine cavity (submucosal); and in between inside the uterine wall (intramural).
Fortunately, most fibroids have minimal or no effect on fertility and may be ignored.
Fibroids That Don't Affect Fertility
The subserosal myoma will rarely cause fertility issues. If it were distorting the tubo- ovarian anatomy so that eggs could not get picked up by the fimbria then it can cause infertility. Otherwise, the subserosal fibroid does not cause problems conceiving.
Occasionally, an intramural myoma may obstruct adequate blood flow to the endometrial lining. The likelihood of this being significant increases with the number and size of the fibroids. The more space occupied by the fibroids, the greater the likelihood of intruding on blood vessels travelling to the endometrium. Diminished blood flow to the uterine lining can prevent implantation or increase the risk of miscarriage. Your fertility doctor may recommend surgery if he believes the number and size of your fibroids is great enough to have such an impact.
Problematic Fibroids Inside the Uterus
However, it is the submucosal myoma, the fibroid inside the uterine cavity, that can irritate the endometrium and have the greatest effect on the implanting embryo.
To determine if your fertility is being hindered by these growths you may have a hydrosonogram. A hydrosonogram is a procedure where your doctor or a radiologist injects water through your cervix 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.
Submucosal, as well as intramural myomata, can also cause abnormal vaginal bleeding and occasionally cramping. Intramural myomata will usually cause heavy but regular menses that can create fairly severe anemias. Submucosal myomata can cause bleeding throughout the cycle.
Though these submucosal fibroids are almost always benign they need to be removed to allow implantation. A submucosal myoma may be removed by hysteroscopy through cutting, chopping or vaporizing the tissue. 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 be performed as an outpatient in an ambulatory or office based surgery unit. The risk of bleeding, infection or injury to the uterus or pelvic organs is small.
Resection of the submucosal myoma can be difficult especially when the fibroid is large and can sometimes take longer than is safe to be performed in a single procedure. It is not uncommon that 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.
The Good News
The good news is, when no other causes of infertility are found, removal of a submucosal fibroid is often successful in allowing conception to occur naturally, or at least with assisted reproduction.