Fibroids and Achieving Pregnancy

Fibroids, which are benign muscle tumors in the uterus, are an extremely common problem and are present in 25% of women over 30. Although fibroids often are asymptomatic, they can produce excessive bleeding, pressure and pain, and most certainly be a cause of infertility. If you have multiple fibroids, they can be removed by an operation called a myomectomy, which involves removing the fibroids one by one. If you have many fibroids, it can require several hours. This operation can be somewhat bloodier than a hysterectomy and in some cases patients donate their own blood prior to surgery. Depending on the location of the fibroids (subserous on the outside of the uterus, intramural within the muscle wall of the uterus, or submucus just underneath the inner lining of the uterus) the approach can be through the abdomen or through the vagina. For subserous and intramural fibroids myomectomy is conventionally done through a regular abdominal incision, although at times using a laparascope with mini-incisions is suitable. If the fibroids are very large, sometimes they are shrunk prior to surgery by injections of Lupron, which create an artificial menopause. I would find a surgeon experienced in myomectomy, and in techniques to avoid adhesions (scar tissue), which can be a complication of this type of surgery, and who is very motivated to save your uterus rather than remove it. Because many couples with fertility problems have more than one cause of fertility, I would be sure to have a thorough hormonal evaluation, make sure the fallopian tubes were open, do NFP charting to assess cervical mucus, and obtain a semenalysis for your husband, so other potential problems can be addressed systematically and not overlooked. Also, you may want to get a second opinion as to whether the fibroids are a significant cause of infertility in your particular situation, and if myomectomy is the logical next step in your fertility workup and treatment.

Dr. Mary Davenport