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Pregnancy and Childbirth: The answers
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Types of Fibroids

For some women, however, fibroids do turn out to be a negative factor or a direct cause of fertility problems. Fibroids that tend to be problematic are those that grow inside the womb cavity. These are called submucosal fibroids.

The other (two) types of fibroids are the ones known as intramural and subserosal. The former grow and are embedded within the wall of the womb and the latter grow outside the womb-cavity appearing to be attached to the womb on the outside (see image on the previous page). There is no evidence that either of these two types could influence fertility.

Some sub-mucosal fibroids grow to a size which virtually fills the womb cavity. A fibroid does not have to be very big to achieve this since a non-pregnant womb is usually rather small, no more than a little girl’s fist. When the cavity is so filled, it may be difficult for an embryo to implant.

In some cases, implantation takes place successfully but miscarriage follows because of the less than ideal environment. Some fibroids could block one or even both openings of the fallopian tubes thus curtailing fertilisation or movement of the fertilized egg into the womb cavity for implantation.

 

Fertility and fibroids: What can be done:

When a woman presenting with infertility is found to have that type of fibroid and when other factors have been ruled out, she could be offered surgical excision of the fibroid. This is if it is of a size or position deemed to be a probable significant factor.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Excision is usually done via a hysteroscope, the so-called key-hole approach. This procedure is extremely safe and successful but is not entirely without risk. There is a very small risk of womb perforation during the procedure. Also, in the aftermath, scarring could develop within the cavity (synechiae) thus complicating the very problem the procedure was meant to solve. However, these complications are relatively rare.

Continues next page

 

Surgery to remove a large fibroid

When the fibroid is very large, it may not be amenable to keyhole (laparoscopic) surgery  and may  reqiure  a classic open surgical approach