These growths that can prevent an embryo from attaching to the uterus can be removed while preserving fertility — if the surgeon takes the correct approach.
My patients work hard to overcome infertility, and together we do everything we can to achieve their pregnancy. So when it comes to removing uterine fibroids my approach is to get rid of the fibroid in a way that preserves a woman’s fertility.
What are uterine fibroids?
They are growths that consist of swirls of smooth muscle in the uterus, also known as the womb. Uterine fibroids are one of the most common problems associated with a woman’s genital tract and commonly affect women of reproductive age.
Uterine fibroids can vary in size, number and location within the uterus, and can cause heavy periods and bleeding in between periods. Fibroids can grow to be very large and often cause painful periods. Other symptoms can include a feeling of pressure, especially with intercourse or exercise, or pressure on the bladder that may cause women to experience frequent urination.
How uterine fibroids affect fertility
Aside from those problems, uterine fibroids can also increase the risk for miscarriage and affect fertility. The reason many women with uterine fibroids may not get pregnant is because the fibroid mass prevents the embryo from implanting onto the uterus. Most often this is caused by a submucosal fibroid — located just under the lining of the uterus — that makes the uterine lining hostile to an implanting embryo.
Facts about fibroids, fertility & pregnancy:
- Fibroids that come very close to, or push into, the uterine cavity decrease the chances of a successful pregnancy, even with IVF.
- Studies have shown that IVF pregnancy rates are lower in women who have fibroids compared with women who do not have fibroids.
- Large fibroids (greater than 5 cm) are associated with a lower pregnancy rate.
- Large fibroids have been associated with premature rupture of membranes, which results in a higher risk of preterm delivery and carries numerous health risks for the child.
- Rarely, fibroids can block or distort the fallopian tubes, or interfere with the passage of sperm from your cervix to the fallopian tubes.
If a pelvic exam or ultrasound discovers that a woman has fibroids after becoming pregnant, the likelihood that the fibroid will affect her child is minimal.
Addressing the situation with the proper solution
It’s often recommended to remove fibroids that are a cause for concern before attempting pregnancy or if a patient has had multiple miscarriages.
My surgical approach has an emphasis on preserving and promoting fertility. Pre-operative and post-operative assessment includes not only the primary problem that requires surgery, but all other factors that might influence fertility after the fibroids are removed. For example, diagnosing male factor infertility or decreased ovarian reserve.
Myomectomy removes the fibroids and leaves the uterus intact, which is the best option to preserve fertility. Myomectomy can be done with minimally invasive laparoscopic surgery using the da Vinci robotic surgery system.