Fibroids and Fertility

Before I jump into today’s topic I wanted to put a plug in for a local patient information seminar sponsored by RESOLVE. The volunteers at RESOLVE do an outstanding job and this conference (April 12, 2008, 8 am til 5pm at the Bethesda, MD Hyatt Hotel) provides a real resource for patients especially in regards to adoption information. http://www.resolve.org.



Now back to our issue at hand…

Every week it seems that I discuss fibroids with my patients…and it is often a rather complex discussion. Fibroids are extremely common, benign tumors of the uterus. They are found in over 50% of women and can range in size from <1cm>50% inside the cavity may be removed with hysteroscopy but those that are not require laparotomy (bikini incision). I am not a proponent of laparoscopic myomectomy unless the fibroid is on a stem. I believe that the repair is inferior through the laparoscope.

Uterine fibroid embolization is a newer approach that should not be used in fertility patients as the technique leaves a large amount of devascularized (no blood supply) tissue and may thus adversely affect fertility.

So here is today’s Question of the Day.

96. Can fibroids or other uterine problems cause infertility or miscarriage?
Anatomical abnormalities can predispose a woman to preg- nancy loss. In particular, congenital uterine abnormalities such as a uterine septum (fibrous band separating the uterine cavity into two smaller cavities) or a unicornuate uterus (a small malformed uterus that is usually connected to a single fallopian tube) can lead to poor reproductive outcomes. Uterine malformations as a result of prenatal exposure to diethylstilbestrol (DES; see Question 66) can also increase a woman’s risk of a poor pregnancy outcome. The presence of uterine fibroids within or abutting the endometrial cavity has been proposed as a source of pregnancy loss (see Figure 7); the same is true of uterine polyps. Extensive intrauterine adhesions from a previous dilatation and curettage (D&C) procedure may also lead to reduced reproductive success. All of these abnormalities may be amenable to surgical correction, but the decision to pursue surgery requires a careful discussion with your physician.