Can I become pregnant with Fibroid
Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Uterine fibroids are the most common tumour in women, and their prevalence is high in patients with infertility.The development of a pregnancy is a multifaceted process. It can be influenced and hindered by various systemic and local factors, such as maternal age, oocyte and sperm quality, parental chromosomal abnormalities, genetic or metabolic abnormalities of the embryo, poor uterine receptivity, and immunological imbalance at the implantation site. Gynaecological conditions that could influence implantation rates include endometriosis, uterine fibroids, hydrosalpinx, and endometrial polyps. Finally, factors such as lifestyle, smoking, alcohol, drugs, and obesity causing insulin resistance might impair the success of reproduction
Uterine fibroids as a possible cause of infertility
Uterine fibroids, also known as uterine leiomyomas or fibroids, are benign smooth muscle tumours of the uterus The symptoms and their severity may differ, depending on the size and location of the fibroids. The most common presenting symptom is heavy menstrual bleeding, which may lead to anaemia, fatigue, or painful periods. Other possible symptoms include lower back pain, pelvic pressure or pain, and pain during intercourse. In the presence of fibroids beyond a certain size, pressure on the bladder or bowel may result in increased micturition frequency or retention, pain, or constipation. Uterine fibroids may also be associated with reproductive problems such as infertility, recurrent pregnancy loss .The International Federation of Gynecology and Obstetrics (FIGO) classification of fibroids.
|
Type |
Location |
|
|---|---|---|
|
Submucosal |
0 |
Pedunculated intracavitary |
|
1 |
<50% intramural |
|
|
Intramural |
2 |
≥50% intramural |
|
3 |
Contact with the endometrium, 100% intramural |
|
|
4 |
||
|
5 |
Intramural |
|
|
Subserosal |
6 |
Subserosal <50% intramural |
|
7 |
Subserosal pedunculated |
|
|
8 |
Other (e.g., cervical, intraligamentous). |
|
|
Hybrid (having contact with both the endometrium and the serosal layer). |
2–5 |
Submucosal and subserosal, each with less than half the diameter in the endometrial and peritoneal cavities, respectively. |
Fibroids and infertility
The adverse effects with subserosal fibroids did not differ from those without fibroids with regard to implantation rates, clinical pregnancy rates, live birth rates, and abortion rates. Thus, subserosal fibroids do not seem to affect fertility .In contrast, submucosal and intramural fibroids that distort the endometrial cavity are associated with lower pregnancy, implantation, and delivery rates in women undergoing in vitro fertilization (IVF) compared to infertile women without fibroids Furthermore, there is a higher risk of infertility when the endometrial cavity is distorted by submucosal fibroids.
Diagnosis
Ultrasonography, preferably by the transvaginal route, is the first-line diagnostic imaging procedure for the detection of fibroids. It is a widely available, economical, non-invasive and painless means of investigating the uterine cavity. The size, exact location, and potential presence of fibroids in the uterine cavity can be assessed. After infusion of saline into the uterine cavity, transvaginal ultrasound is able to demonstrate submucosal fibroids and indicate the proximity of intramural fibroids to the cavity. Fibroids are usually hypoechoic or isoechoic. MRI is also used occasionally for mapping of fibroids.
Management
Treatment options for fibroids include surgery, medication, and interventional radiology. The treatment improves symptoms by reducing the size of the fibroids, controlling abnormal uterine bleeding, or even curing the fibroids .
Thorough preoperative assessment is essential to determine the surgical strategy according to the size, location, and number of fibroids. A precise preoperative diagnosis will indicate whether a hysteroscopic resection or a laparoscopic myomectomy is feasible,.Currently, hysteroscopic myomectomy is the gold standard for surgical treatment of submucosal fibroids (FIGO 0 and 1 fibroids]. FIGO 2 fibroids are more difficult to resect and may require a two-stage treatment, especially if they are larger than 3 cms.Laproscopic myomectomy are indicated in intramural myomas .
Management is according to location, The Recommendations are:
Submucosal fibroids should be removed before ART or in cases of habitual abortions.
Subserosal fibroids as they do not seem to affect pregnancy rates, myomectomy does not appear to be necessary.
Intramural fibroids: controversial data, lack of homogenous opinion. Intramural fibroids ≥5 cm: perform surgery before ART or in cases of habitual abortion. Intramural fibroids <5 cm: the reported outcome varies between no difference and significantly reduced cumulative pregnancy rates.
To sum up Fibroids and infertility are closely related and they should be dealt with extreme precision.
