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Do Fibroids Cause Infertility?
By Francis Polansky, M.D.
You may feel quite upset if you have received a diagnosis of uterine fibroids (myomas). Will the presence of fibroids keep you from getting pregnant? Will they cause a miscarriage? Can they endanger the developing baby? Could they be a problem during the delivery?
Uterine fibroids are one of the most common gynecologic conditions. It is estimated that over half of all women will develop a uterine fibroid during their lives. Most of these women will not need any treatment or intervention.
Fibroids are non-cancerous excessive growth of muscle cells originating from the uterine wall. Most of them stay small, but on rare occasions, fibroids can become very large and weigh several pounds. Large fibroids located low in the pelvis may interfere with vaginal delivery and such fibroids may need to be surgically removed prior to attempts at conception.
Fibroids can occur in the following three locations: on the outside of the uterus (subserousal), within the uterine wall (intramural), and within the endometrial cavity inside the uterus (submucousal). In the first two locations, fibroids will not necessarily make it harder for you to conceive. Fibroids inside the endometrial cavity, even if they are very small, could significantly reduce the probability of pregnancy.
Fibroids and polyps inside the endometrial cavity can act a bit like an intrauterine device (IUD) in keeping implantation from taking place.
Large fibroids within the uterine wall can be a cause of miscarriages if pregnancy happens to implant right over the fibroid. As the pregnancy grows and its nutritional requirements increase, there may be an insufficient penetration of blood vessels through the fibroid.
We use saline ultrasound (sonohysterogram) to assess the endometrial cavity prior to the beginning of treatment and to screen our patients for the presence of fibroids and polyps inside the uterus.
This ultrasound image shows a normal endometrial cavity. Fibroids and polyps would show as lighter shade "filling defects" within the dark saline-filled endometrial cavity.
If intrauterine fibroids or polyps are found, they can usually be removed by an operative hysteroscopy, a simple surgical procedure performed by your gynecologist. The healing after this type of fibroid or polyp removal is so rapid that most of the time the timing of your infertility treatment does not have to be altered.
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