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Fertility and Fibroids: What can be done:

When a woman presenting with infertility is found to have that type (submucosal) of fibroid and, when other factors have been ruled out, she could be offered surgical excision of the fibroid. This is if it is of a size or position deemed to be a probable significant factor. Excision is usually done via a hysteroscope, the so-called key-hole approach. This procedure is extremely safe and successful but is not entirely without risk. There is a very small risk of womb perforation during the procedure. Also, in the aftermath, scarring could develop within the cavity (synechiae) thus complicating the very problem the procedure was meant to solve. However, these complications are relatively rare.

In the last few years, dedicated submucosal fibroid resection systems which are significantly easier to execute  have emerged. What is more, because of the way they work, risk of internal scarring as a result of the surgery is minimised even further.  Myosure fibroid resection is one such method. This can even be carried out in an outpatient (office) setting under local anaesthetic only.

Fibroids and delivery

Fibroids can also impact timing and mode of delivery. There is evidence, albeit weak, that some fibroids could trigger early onset of labour and preterm delivery. This is not a common.

Some submucosal and intramural fibroids do distort the cavity causing the baby to assume an abnormal position. This, in effect, means a caesarean delivery becomes inevitable.

Fibroids can also increase the risk of heavy blood loss after delivery, be it vaginal or by caesarean section. This is not common.

In some cases fibroids do interfere with the mechanism of contractions during labour. This can be to an extent that intervention in the form of caesarean section becomes necessary.

Effect of Pregnancy on Fibroids

Sometimes fibroids increase significantly in size during pregnancy. This is thought to be the effect of the estrogen hormone, the levels of which are quite high during pregnancy.

Fibroids can also undergo degeneration during pregnancy. Red degeneration is characterized by quite severe pain which is because the fibroid suddenly loses its blood supply and in effect dies. This could trigger onset of labour, even prematurely. It is rare.

Fibroid surgery during pregnancy

It is difficult to see any indication of fibroid surgery during pregnancy. In fact this is probably always an out and out bad idea as it is likely to be fraught with risk of heavy bleeding and could even trigger a miscarriage.

In Summary

There are many ways in which fibroids can influence fertility, pregnancy and delivery. However, in the overwhelming majority of cases, presence of fibroids is of no consequence and they are innocent bystanders.

Last update: March 21, 2013

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