By Dr Alwyn Dunn, City Fertility Centre Gold Coast.
When you have been diagnosed with fibroids, you might immediately ask yourself whether you’ll be able to have a baby.
It is important to understand that not every fibroid impacts on your fertility and for those types that do, treatment options are available. Fibroids should also not automatically be considered the cause of your infertility, but in appropriately selected cases the removal of the fibroids appears to improve fertility.
Treatment options depend on the size, number and location of the fibroids and your fertility ambitions.
Fibroids (uterine leiomyoma), which are benign pelvic tumours, are common, affecting up to 70 per cent of women during their lifetime. They vary in size, with symptoms including abnormal uterine bleeding in the form of heavy menstrual loss, pelvic pressure, pain during intercourse and/or difficulty with urination and defecation. However, many women with fibroids will not experience any symptoms at all.
Fibroids are often present in women who are having trouble falling pregnant and hence are seeking fertility treatment.
The impact of fibroids on fertility often depends on the type you have.
Subserosal fibroids do not appear to have any effect on fertility and therefore removal of these is usually only done based on the secondary effects caused by pressure on adjacent organs.
Intramural fibroids may be associated with reduced fertility and increased miscarriage rate. Removal is justified if this association is present.
Submucosal fibroids are associated with reduced fertility and increased miscarriage rates. Any documented infertility in association with the submucosal fibroids justifies their removal.
The relative effects of multiple or different-sized fibroids on fertility are uncertain but any infertile woman with symptomatic fibroids has a justification for intervention by surgical treatment.
Fibroids can be treated by several means, including medications (such as the contraceptive pill), surgical procedures (such as myomectomy or hysterectomy), embolisation and MRI-guided ultrasound.
For females who are considering having a baby in the future, at this point in time I believe a myomectomy is a safe and effective treatment for symptomatic fibroids. While the outcomes for abdominal and laparoscopic myomectomy are similar, the laparoscopic procedure produces a more rapid recovery and fewer adhesions. It is possible to resect large fibroids laparoscopically but the outcome is influenced by the experience of the surgeon.
Research has found a pregnancy success rate of 40 to 60 per cent two years after abdominal or laparoscopic myomectomy in conjunction with fertility treatment.
There is currently no agreed official timing for how soon a woman can try for a pregnancy or have IVF after a myomectomy. While the documented rate of uterine rupture is low for both abdominal and laparoscopic myomectomy, most obstetricians recommend an elective caesarean.
