Fibroids are sometimes found during an infertility evaluation when
tests such as a pelvic ultrasound, hysterosonogram or hysterosalpingogram are
ordered.
Fibroids or leiomyomas are benign smooth muscle tumors of the
uterus.
They are classified according to their location in three types:
(1) subserosal - when the fibroid grows under the outer layer or
serosa of the uterus;
(2) intramural - when the fibroid grows within the muscular wall
of the uterus (myometrium), and
(3) submucosal or intracavitary- when the fibroid grows just under
the lining of the uterine cavity (mucosa) or it occupies the inside of the
uterine cavity.
Submucosal or intracavitary fibroids can change the shape of the
uterine cavity.
Large intramural fibroids may alter the blood flow to the uterine
lining and may also alter the shape of the uterine cavity. Subserosal fibroids
usually don't alter the shape of the uterine cavity, but when large can cause
discomfort.
Most fibroids are usually small, asymptomatic, and don't require treatment.
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These benign tumors only need close gynecological observation to
document changes in size or the early onset of symptoms. Common symptoms
associated to fibroids are back pain, abdominal pressure or discomfort, urinary
frequency, rectal pressure or discomfort, and periods that can be painful,
heavy and prolonged.
Fibroids are associated with infertility in 5 to 10% of cases. Nevertheless, when all other causes of infertility are excluded fibroids may account for only 2 to 3% of infertility cases.
Fibroids may cause reduced fertility or infertility by:
1. Creating an abnormal uterine cavity. An enlarged or elongated cavity could interfere with the sperm transport, and a cavity with an abnormal contour could prevent normal implantation.
2. Fibroids can result in a markedly distorted uterus and cervix.
The distortion could result in decreased access to the cervix by
the ejaculated sperm preventing its effective transport to the uterus.
3. The uterine segments of the fallopian tubes could be obstructed
or distorted by fibroids.
When infertile women present with uterine fibroids every effort should be made to exclude any other possible causes of infertility.
A standard infertility evaluation should take place and an
assessment of the uterine cavity should be performed by hysterosalpingogram
(HSG) or "fluid" ultrasound (hysterosonogram).
Only then a decision should be made regarding the management of
the fibroids.
Most uterine fibroids don't need to be removed except in select cases.
The medical literature suggests that removal can be beneficial
when the uterine cavity is distorted by the fibroids.
In addition, some reports suggest that their removal may also be
indicated when they are 5 centimeters or more in diameter and are located
within the wall of the uterus (intramural).
Otherwise, expectant management is recommended when the uterine
cavity is normal, the fibroids are small, or when they are located on the
surface of the uterus.
Fibroids are removed in a surgical procedure called a "myomectomy". Three types of myomectomy can be performed: abdominal myomectomy, laparoscopic myomectomy, and hysteroscopic myomectomy.
The abdominal myomectomy requires an abdominal incision usually of
the "bikini" type, and through the incision the fibroids are removed
from the uterus.
This abdominal approach is the best procedure when fibroids are
large, numerous, and or located deep within the muscle of the uterus.
Fibroids can also be
removed by laparoscopy, and this type of myomectomy is best when fibroids are
few in number, superficial in location and small in size.
Hysteroscopic myomectomy is recommended when most of the fibroid
is located within the cavity of the uterus.
Through the uterine cervix an operative hysteroscope is inserted
and the myomectomy is then performed.
Endoscopic scissors, laser or electrocautery are employed to
perform this type of myomectomy.
A myomectomy is a relatively safe procedure that results in few serious complications.
Postoperative adhesion formation is a common complication and good
surgical technique combined with adhesion-prevention barriers should be
routinely used at myomectomy.
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There are other options for the treatment of uterine fibroids, but these alternatives are not recommended for women who desire fertility. Some of these options are:
1. Uterine artery embolization (UAE) - results in the obstruction of blood flow to the fibroids, which then causes them to shrink.
This procedure is quite
successful in reducing tumor size and decreasing symptoms.
Pregnancies have been reported after UAE but the safety of this
procedure in women who want to get pregnant has not been established.
2. Medical therapies with agents such as GnRH agonists, progestational agents, and RU486 (mifepristone).
These agents can decrease uterine size and symptoms, but once the
treatment is discontinued the fibroids can grow back to their initial size.
The use of these drugs is not effective in promoting fertility and
is not recommended when women are attempting pregnancy.
3. New techniques are being developed for the treatment of uterine fibroids.
One of these new techniques is laparoscopic myolysis in which a
needle is used to apply electric current directly to fibroids. The goal is to
disrupt the blood flow of fibroids and cause them to shrink over time.
A similar laparoscopic procedure uses super cooled cryoprobes to
destroy the fibroids.
Another technique uses magnetic resonance imaging (MRI) to target
a high intensity ultrasound waves to destroy the fibroids.
Again, the safety of these
procedures in women who want to get pregnant has not been established.
Educating yourself about your options and your physician treating you for fibroids is essential.
Go to Dr. Troche's West Valley Fertility Center Arizona and get
more information and knowledge.
Article Source: http://EzineArticles.com/expert/Vladimir_Troche,_M.D./240274
Article Source: http://EzineArticles.com/1332193
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without surgery and drugs? Find out the 3-step
powerful system thousands of women worldwide
had been using to naturally treat their fibroid
pain and other related symptoms within 12 hours
and fix the root cause of their uterine fibroid
permanently within 2 months