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Fibroids and Infertility

Fibroids are the most common tumour, which are of noncancerous origin, arising in the uterus, and are commonly seen in females of the reproductive age group. So yes, they are often labelled as tumours but then the misnomer is that these are not malignant.

The incidents are seen in about 50-70% of the females of the reproductive age group, the symptoms will be seen in only 20-30% of these people and roughly about 5-10% of infertile females will have an associated finding of fibroids.

The exact cause has not been elucidated till date but , a genetic linkage and a hormonal association has been seen.

Now going back to our important question is whether the fibroids are related to fertility? Yes, they are.

And how?

They are usually the mechanical effects of fibroids, especially in females where the fibroid is located typically in the uterine cavity or there is impairment in the uterine contractibility or impaired implantation, i.e. the sticking of the baby to the uterus. These factors individually or in combination can eventually lead to fertility issues or repeated pregnancy losses.

Diagnosis

Usually incidental on ultrasound ,but the gold standard is 3D ultrasound and sometimes MRI or sonosalpingogram .

Coming to the treatment ,depends upon the location of fibroids , there is medical treatment which is effective for a few group of patients ,but in maximum symptomatic , submucosal or larger intramural and subserosal fibroids ,we might require hysteroscopic or laparoscopic removal.

To summarize, fibroid is the most common noncancerous tumour in the reproductive age group. About 5-10% of the infertile females will have associated findings of fibroid, but fibroid as the sole cause of fertility would be seen in just 1.5-2% of the population. Medical management as a standalone treatment to treat fertility in patients with fibroid is not enough. Any tumour distorting the cavity or in the uterine cavity has to be removed.

Whether to remove any tumour which is present in the body of the uterus not distorting the cavity is still a debatable issue. The pros and cons of the procedure should be well evaluated and also all the factors which could attribute towards failure of a fertility treatment, either IVF or ICSI or any other ART modality should be evaluated and ruled out first before contemplating your surgery.