Fibroid and infertility ---A Story
31 yrs old patient came in gynae OPD for IVF as advised by her consultant .She was trying for conception from last once year though she has been married from last 7 years .She and her husband has been living separately before that .
She had a history of severe dysmenorrhea and had a fibroid around 4 cm slightly distorting the cavity so she underwent myomectomy with tubal evaluation and was diagnosed with grade 1 endometriosis .Her husband”s investigations and semen analysis was normal. The laproscopy was done three months back in Australia
The painful periods continued post laproscopy and now the flow became excessive with around seven pads per day and flow lasted for around 10 days.She was referred for IVF .Her ovarian reserve test were normal and after all the blood work up ,TVS was done for the assessment and it showed a large submucous fibroid around 4.6 cm and both the ovaries were normal .Submucous fibroids are the most notorious as far as infertility and painful periods are concerned .The decision was very painful as she has undergone one surgery for this 3 mths back only,
Laproscopic approach was planned owing to the big size.Although hysteroscopic myomectomy is possible but it has to be done in stages . During laproscopy, incision was made in the posterior wall and around 5 cm fibroid removed .Uterus stitched in layers .an ultrasound was done intraoperative to confirm the complete removal of the fibroid. The patient is advised to avoid pregnancy for 3 to 6 mths and then she will be able to conceive .
Submucous fibroids are noncancerous growths that develop within the inner lining of the uterus (the endometrium). These fibroids can impact fertility and pregnancy in several ways:
How Submucous Fibroids Affect Fertility:
- Interference with Implantation: Submucous fibroids can distort the uterine cavity, making it difficult for a fertilized egg to implant properly.
- Altered Uterine Environment: They can change the local environment of the uterus, affecting the endometrial lining's ability to support a pregnancy.
- Blockage of Fallopian Tubes: If a fibroid is large enough or improperly located, it can block the fallopian tubes, preventing sperm from reaching the egg.
- Increased Risk of Miscarriage: The presence of submucous fibroids has been associated with a higher risk of miscarriage, possibly due to the altered uterine environment.
- Hormonal Imbalances: Although fibroids themselves are non-cancerous, they can produce local hormonal changes that might interfere with normal reproductive function.
Symptoms of Submucous Fibroids:
- Heavy or prolonged menstrual bleeding
- Pelvic pain or pressure
- Frequent urination
- Difficulty emptying the bladder
- Constipation
- Back or leg pain
Diagnosis and Treatment:
Diagnosis:
- Ultrasound: A transvaginal or abdominal ultrasound can help visualize fibroids.
- MRI: An MRI can provide detailed images of the uterus and fibroids.
- Medications: Hormonal treatments can help manage symptoms but do not eliminate fibroids.
- Hysteroscopic /Laproscopic Myomectomy: A surgical procedure to remove submucous fibroids , preserving the uterus.
- Uterine Artery Embolization (UAE): A procedure to cut off the blood supply to fibroids, causing them to shrink.
- Endometrial Ablation: A procedure to destroy the lining of the uterus, which can help control heavy bleeding but is not recommended for women who wish to conceive.
Fertility Treatment Options:
If submucous fibroids are affecting fertility, treatments like hysteroscopic myomectomy can improve the chances of conception. Assisted reproductive technologies (ART) such as in vitro fertilization (IVF) may also be considered in cases where natural conception is challenging.
It's essential for women with submucous fibroids who are trying to conceive to work closely with their healthcare provider to develop a tailored treatment and plan pregnancy