Fertility Chronicles is proud to present a special blog series, “From the Fertility Experts,” where leading fertility experts answer commonly asked questions for patients about their fertility health and treatment options. We hope this series can help patients navigate their personal fertility journeys.—Catherine T. Yang, Editor, Fertility Chronicles
In Part I of his two-part series last week, Dr. Antonio R. Gargiulo, our guest blogger, shared his advice on the impact of uterine fibroids on fertility. In his blog this week, he explains surgical options for fibroids:
Last week, I wrote about the impact of uterine fibroids on fertility. I’ll review a little of that information before addressing this week’s topic on surgical options for fibroids.
Uterine fibroids are benign, smooth muscle cell tumors that affect 25% to 45% of reproductive-age women. There is no consensus on how fibroids may interfere with conception, but recent studies have begun to shed light on this controversial topic.
Depending on their genetic make-up and their degree of natural degeneration, fibroids may secrete different local hormone-like substances that interfere with the ability of the uterine muscle to contract, as well as with critical messages traveling between the uterine lining and the embryo. If such molecular communications are altered, the embryo may not implant successfully or stop developing, leading to miscarriage. That is why some women with fibroids do not have difficulty conceiving but experience recurrent pregnancy loss.
We have no way to clinically differentiate if a fibroid is of the type that will do damage. Therefore, we currently work on the assumption that all fibroids have the potential to disrupt the reproductive process, and we counsel patients based on the size and location of fibroids instead, as assessed by radiologic imaging. In my last blog, I explained the characteristics of fibroids found in different locations.
Reproductive surgeons often resolve difficult infertility or recurrent pregnancy loss cases with a focused surgical intervention to remove clinically significant uterine fibroids. To determine the best course of action, your infertility doctor will perform an evaluation, which may include one or more imaging studies. Some examples of imaging studies are ultrasound, magnetic resonance imaging, hysteroscopy, and hysterosalpingogram. Based on the type, location, and size of your fibroid(s), and any of your other symptoms or diagnoses, your doctor will determine the tests you need. If your doctor believes that fibroids are preventing pregnancy or increasing the risk of miscarriage, he or she may recommend surgery. With rare exceptions, fibroids in women of reproductive age should be removed endoscopically, that is to say, with a minimally invasive surgical approach. Minimally invasive myomectomy (fibroid removal with sparing of the reproductive organs) is performed via laparoscopy or via hysteroscopy. Laparoscopy is a procedure that uses small tubular instruments that enter the abdominal cavity through the skin. Laparoscopy can be performed by hand or with the assistance of a surgical robot: both techniques are safe and effective in the hands of expert operators, and both offer far superior outcomes compared to conventional open surgery. Hysteroscopy, a procedure that accesses the womb through the vagina and cervix, is the least invasive of all surgical procedures and should be preferred over the others when feasible (only feasible for certain submucosal fibroids).
The decision to undergo surgery depends on many factors, including your overall health. In particular, delaying conception for surgery and recovery can be a tough choice. In many situations, it may be worth trying to conceive and to remove the fibroid only if you have difficulty conceiving or miscarry. The decision on when to operate is also significantly influenced by the prospect of a long recovery needed following conventional open surgery vs. a short recovery needed following endoscopic surgery. That is why access to an expert minimally invasive reproductive surgeon is essential for women in reproductive age dealing with uterine fibroids.
Although having fibroids may cause anxiety and create extra hurdles to family-building, rest assured that this is a common, benign condition, and your doctor can help steer you.
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