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FIBROIDS AND FERTILITY

Summary



Infertility usually is not a consequence of uterine fibroids. When the two situations occur together, the myomas can exert an effect by mechanical obstruction, distortion or interference with implantation. Most women with myomas are fertile. When mechanical obstruction of the uterine cavity is present, and no other cause for the infertility can be identified, myomectomy is usually followed by prompt achievement of pregnancy (within the first year) in a high percentage of patients.

Intracavity myomas usually require surgery. This is best achieved by hysteroscopic resection. Large myomas of greater than 5 cms in diameter may be difficult to resect hysteroscopically. Medical therapy with a GnRH agonist is not recommended in these situations.

Most myomas do not grow during pregnancy. If they do, they usually regress in size after delivery. Myomas occasionally undergo red degeneration in pregnancy. This is a condition associated with central hemorrhagic infarction and can result in severe pain, nausea, fever, rebound tenderness and leucocytosis. Conservative management is called for, with surgery as a last resort.

Women who have fibroids are more likely to have problems during pregnancy and delivery. This doesn't mean there will be problems. Most women with fibroids have normal pregnancies and normal deliveries.

The most common problems seen in pregnant women with fibroids are:

  • Cesarean section. The risk of needing a c-section is six times greater for women with fibroids.
  • Baby is breech. The baby is not positioned well for vaginal delivery.
  • Labor fails to progress.
  • Placental abruption. The placenta breaks away from the wall of the uterus before delivery. When this happens, the fetus does not get enough oxygen. This requires emergency intervention to rescue the baby and mother.
  • Preterm delivery.


Talk to your obstetrician if you have fibroids and become pregnant. Most obstetricians have experience dealing with fibroids and pregnancy.