During this session, Dr Elias Tsakos, FRCOG, Medical Director of Embryoclinic – Assisted Reproduction Clinic in Thessaloniki discussed whether uterine fibroids, myomas, and other benign tumours can interfere with fertility and how to treat them to achieve a positive outcome.
The uterus plays a crucial role in implantation and pregnancy, yet it is often overlooked when investigating reproductive issues.
Fibroids, also known as leiomyomas or myomas, are usually benign tumours, although approximately 1 in 500 myomas can be malignant. They are typically round and can be found in various areas of the uterus, including the uterine cavities, myometrium, or the external part. In some cases, fibroids may be located near the ovaries or present as ovarian cysts. Fibroids are quite common, with around 80% of women having small fibroids, and approximately 50% of women experiencing symptoms. Even women who have completed their families or entered menopause can be affected by fibroids, emphasizing the need for awareness and appropriate management. Treatment may be required for about 30% of women with fibroids, and up to 60% of those may require additional treatment.
These congenital malformations are relatively common, especially among women with fertility issues. Detecting uterine anomalies is crucial before starting any fertility treatment. Scanning alone may not be sufficient for a confident diagnosis, so additional imaging techniques such as saline or foam hysterosalpingograms (HSG) or standard X-rays are important. The prevalence of uterine anomalies is higher in women with fertility challenges or miscarriages, highlighting the importance of thorough investigation before proceeding with fertility treatments like in vitro fertilization (IVF).
Fibroids can manifest through pain, infertility, heavy bleeding, or pressure symptoms on various organs. While some fibroids may be asymptomatic, they can still impact fertility. The size and location of fibroids determine the management approach. For instance, a small fibroid (around two to two and a half centimetres) within the uterine wall, without distorting the cavity, poses a decision-making challenge for infertility cases. Should it be removed or closely monitored? This decision requires individual consideration. In general, a conservative approach is preferred, but factors such as fibroids within the uterine cavity, rapid growth, symptoms, failed IVFs, or miscarriages may necessitate intervention. Individual counselling is crucial in such cases, along with specialized ultrasound scans (e.g., 3D or Doppler studies), MRI scans, hysteroscopy, and occasionally laparoscopy to assess the fibroids thoroughly.
In conclusion, managing uterine conditions requires a comprehensive understanding of fibroids and congenital anomalies. Their impact on fertility varies, and treatment decisions should be tailored to each patient.
Fibroids and congenital uterine anomalies are well-known factors that can negatively impact fertility. The team at Embryoclinic has researched the effect of robotic and laparoscopic management of fibroids on fertility. Similarly, studies have shown that congenital uterine anomalies can also affect fertility. It is crucial to address these issues and not proceed with in vitro fertilization (IVF) until the uterine cavity and wall have been confirmed as normal. Further investigations, such as 3D ultrasound and MRI scans, should be conducted to ensure that patients do not experience repeated failed IVFs or miscarriages due to undetected uterine anomalies.
There are various treatment options for fibroids and uterine anomalies. These include watchful waiting, non-invasive medical treatments, minimally invasive options such as laparoscopy and robotic surgery, radiofrequency ablation, traditional surgery, and vascular embolization. However, it is important to note that certain options are not recommended for women seeking fertility. Individualization and consultation with a specialized team of doctors in fertility and surgery are crucial in determining the best course of action.
Myomectomy, specifically through minimally invasive techniques like hysteroscopy or laparoscopy, is superior in terms of fertility outcomes compared to other options. Robotic surgery, a state-of-the-art technology, has shown significant advantages over conventional laparoscopy, especially in Myoma surgery for patients seeking fertility. Our team has conducted an extensive review of the outcomes and benefits of robotic myomectomy, which is currently under review for publication. The results indicate improved pregnancy rates, reduced miscarriage rates, shorter conception time, and higher live birth rates. Hysteroscopic management is also important for treating congenital anomalies and has provided successful results in the last two decades.
Anomalies of the uterus can have a significant impact on fertility and may present various clinical manifestations. They are often an underlying cause of infertility, which can be missed during comprehensive investigations. Surgical treatment, particularly minimally invasive approaches, is the most effective option for fertility patients. These solutions not only improve fertility outcomes, but also enhance the quality of life for patients. It is essential to address uterine anomalies and fibroids to prevent undiagnosed and untreated conditions that can hinder fertility.- Questions and Answers