Uterine fibroids (also called myomas or leiomyomas) are abnormal growths that consist of muscle cells and fibrous tissues that form a mass within the uterus. According to the National Institutes of Health, 20 to 50 percent of women of childbearing age have fibroids and 70 to 80 percent of women are having fibroids by the age of 50. The exact cause of uterine fibroids is undecided, but there is enough data to substantiate that it may be a combination of hormonal, genetic and environmental factors. The good news is that fibroids are non-cancerous (benign) uterine growths.
There are four types of fibroids
- Intramural (the most common forms of uterine fibroids and are found in the muscular layers of the uterine wall at their worst, can grow to stretch the uterine womb.)
- Submucosal (This has been linked to impaired fertility and protrude into the uterine cavity)
- Subserosal (that grow on the outer wall of the uterus sometimes expand to make the womb appear larger on one side)
- Pedunculated (that grow on a stalk or pedunculate either inside or outside of the uterus).
Can fibroids decrease fertility?
The size and location of a fibroid determine whether it will affect your fertility. Most women with fibroids don’t have to be infertile nevertheless, it is best to consult with a fertility specialist to find out if the fibroids are hampering your ability to conceive.
In general, the subserosal, intramural fibroids, and pedunculated fibroids may cause pain and discomfort, they do not affect fertility. However, fibroids that impinge upon the endometrial cavity (submucosal fibroids (with or without intramural fibroids)) or is larger than 6 cm in diameter, then it may hamper conception by up to 70%. Other fibroids that can cause considerable problems is the one that grows off the back side of the uterus and occupies the cui de sac (area behind the uterus) to a greater or lesser degree. Fibroids surgery can also have an effect on fertility in some ways. There is a possibility of post operative adhesion formation within the uterine cavity if the endometrial cavity is entered during the surgery. Myomectomy procedure to remove uterine fibroids can be blood-spattered and has a high likelihood of abdominal adhesion formation. This could obstruct the ends of the fallopian tubes, or enclose the ovaries, preventing the release of the eggs or otherwise impede with the normal functioning and relationships of the pelvic organs. For this reason, it is important that only accomplished surgeons should perform myomectomies.
The major concern in pregnancy is whether the fibroid will increase the chance or preterm birth or miscarriage. There may be accelerated fibroid growth during pregnancy as it increases the production of estrogen. Sometimes fibroids can outgrow their blood supply and may cause severe pain. While most women with fibroids do not experience complications during pregnancy, 10 percent of pregnant women do have abdominal pain accompanied by light vaginal bleeding. However, the need for cesarean section is more common among women who have fibroids.
The uterine fibroids may impact fertility in the following ways:
- Changes in the shape of the cervix which have an effect on sperm count entering the uterus.
- They can change the shape of the uterus which can interfere with the movement of the sperm or embryo.
- Fibroids can impact the size of the uterine cavity lining.
- Fallopian tubes can be blocked by fibroids.
- The amount of blood flow to the uterine cavity can be affected thus decreasing the ability of an embryo to get implanted into the uterine wall or to develop.
Diagnosis and Treatment Options
During your next routine check-up, consult with your gynaecologist about including a pelvic exam for uterine fibroids. Your doctor may schedule an ultrasound or an MRI-guided exam following a regular pelvic exam for those who are concerned that they may have a fibroid. Simple bi-manual vaginal examination usually identifies larger fibroid tumors and even the smallest fibroid can be identified by transvaginal ultrasound. Hysteroscopy or a hysterosonogram can help distinguish between intramural and submucosal. To distinguish between fibroid tumors and a related condition called adenomyosis, MRI is used.
Fibroid treatment options include a variety of non-surgical options with low risk factors or surgical procedures including a common myomectomy. Small, asymptomatic fibroids that do not impinge upon the endometrial cavity are generally monitored for growth instead of removing them. Your gynaecologist may recommend removing any large fibroids or submucosal fibroids if you are starting fertility treatments such as In Vitro Fertilization (IVF), in order to decrease the chance of implantation failure, pregnancy complications or miscarriage. Subserosal and Intramural fibroids are usually removed by laparoscopic resection or via an abdominal incision.
For over 15 years now, GIFT Gyno hospital Cochin have been helping couples fulfill their dreams to become parents with expert treatments and dedicated care. The hospital was established in 2003 as a centre for excellence in infertility, high-risk pregnancy, and laparoscopic surgery. GIFT- Gyno IVF centre was introduced in 2007 with the establishment of state of the art, ART lab maintained by a full-time embryologist. The infertility specialists Kerala has a reputed team of fertility experts, nursing staff, the clinical support team, counselors together with the world-class facilities, to address all concerns related to infertility and ensure the best chance of pregnancy. GIFT Gyno hospital is a designated Center of Excellence in Minimally Invasive Gynecological surgery and Fibroids treatment in Kerala. Book your appointment today with the experts or send an enquiry for uterine fibroids surgery Kochi.