Friday, 28 November 2014

Should you have your fibroids removed to attain pregnancy ?



Fibroids  are just benign tumors of the uterus and around 30 % of women develop fibroids as they enter their thirties.

The relation between fibroids and fertility is often confusing to the patients. The clinician has to find out the location and size of fibroid to ascertain, if it can cause any negative effect on pregnancy. The fibroids can be left alone if they are small and do not affect the chance for a healthy pregnancy.

There are different types of fibroids depending on the location. If they are small, situated on the outer lining and growing outside the uterus (subserous fibroids),  generally they do not hinder conception,  unless they are very close to the area  of the opening of the tubes.

Big sized fibroids (more than 5 cm) may have negative effect on pregnancy, even if they are located on outer lining due to the alteration in the anatomy, as the sheer weight might change position of uterus, thus reducing chance of egg pickup by the fallopian tubes.


If the fibroids are small and situated in the myometrium,  inside of  muscle mass of the uterus (intramural fibroids), they may be harmless if they are less than 2 cm, but larger ones may reduce chances of  pregnancy.



Laparoscopic myomectomy ( removal of fibroids) is a good option to remove subserous fibroids  and the intramural fibroids.


Most of the fibroids which grow near the inner lining  and bulge into the uterine cavity   distort the cavity where the baby has to grow leading to infertility or subfertility. Even a tiny fibroid of .5 cm can be bad news, if it is submucous (inside the uterus). These kinds of fibroids need to be removed by endoscopic surgery and it can be done by hysteroscopic myomectomy.

If the fibroids are causing symptoms due to compression on nearby structures like bladder and ureter, then they have to be  removed.

Although there are injections to shrink fibroids, the results are temporary and stops ovulation in the woman, so this may not be the right treatment for subfertility. The only indication would be to give them prior to surgery.

Even after considering all these factors, the treatment cannot be generalised,  as it will be different for  different individuals. To  make a decision, the clinician has to personally do a detailed transvaginal scan to assess whether to go for a  surgery or not.

It needs to be kept in mind that  surgery does have a very small risk of hysterectomy (removal of uterus) in case of bleeding. Heavy bleeding during the procedure is a potential risk, especially in complicated cases, wherein any surgeon would opt to remove the uterus to save the patient's life.

We see many patients coming for  surrogacy  with history of failed IVF and failed surgery, as the fibroids tend to reoccur after removal. Surrogacy is a good option for women with multiple large fibroids where hysterectomy is needed, or in cases of  recurring fibroids.

for more details you can visit the following blogs



Dr. Anita Mani
Infertility& Surrogacy Specialist at Gift IVF Centre
anitadane@gmail.com

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Dr. Anita Mani is a renowned infertility specialist in south India with 15 years experience in ART (Assisted Reproductive Technology). Dr. Anita has successfully set up ART hospitals in Cochin and Bangalore,  along with her spouse  Dr. S Mani, who specialises in surrogacy. She completed MRCOG, from Royal College of Obstetrician and Gynaecologist  London, DFFP from  ART Warwick university and  worked in UK for 5 years. Dr. Anitha believes in scientific and ethical practice and is currently the director of Gift Gyno IVF centre Cochin and  Bangalore.  Apart from advanced laparoscopic surgeries, she is also an expert in various ART techniques including IVF, IUI, ICSI , donor egg / sperm  and surrogacy. Her proficiency is in genetic abnormalities and high risk pregnancies.

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