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Fibroids and Fertility

Can fibroids decrease fertility?

Uterine fibroids are common, and they are found in 5-10% of infertile women. Certain types of fibroids are known to decrease fertility. They include fibroids that are inside the uterine cavity and very large fibroids that are located within the wall of the uterus. As most women with fibroids will not be infertile, an experienced fertility specialist can help determine if fibroids might be hampering their ability to conceive.

How do fibroids cause infertility?

There are several explanations for why uterine fibroids may reduce fertility.

  • Affecting the blood flow to the uterine cavity where the embryo would implant.
  • Changes in the shape of the uterus can interfere with sperm movement.
  • Blockage of the fallopian tubes by the fibroids.

What happens to fibroids during pregnancy?

Fibroids can increase the risk of miscarriage. Some fibroids will increase in size and complicate a pregnancy. If a fibroid grows, it will typically do so in the first 12 weeks of pregnancy.

What can happen if a fibroid does grow during pregnancy?

In some instances, fibroids can possibly outgrow their blood supply and cause severe pain that might lead to hospitalization. Also, fibroids can change the baby’s presentation (position at birth), increase the risk of a cesarean section, miscarriage and preterm delivery.

Summary

Uterine fibroids are common and can affect fertility in many ways. They can affect ovulation, fertilization and implantation. Treatment options vary, but treatment will help to address the gynecologic symptoms of fibroids and improve overall fertility. The management of uterine fibroids will depend upon the severity of your symptoms.

Treatment of Fibroids

Conservative

Wait and see approach with Ultrasound scan monitoring

Medical treatment of Fibroids

There are currently no medicines that will cure fibroids. Medication can be used temporarly to shrink the fibroids and which may improve symptoms until the effects of medication have worn off. These included Ulipristal acetate and GnRH analougues such as Zoladex.

Embolisation of Fibroids

This treatment involves blocking the blood supply to the womb and is known as Uterine Fibroid Embolisation – UFE. Whilst it is useful in reducing the size of Fibroids, there remain concerns about the effects a reduction in the blood supply to the womb may have on Fertility and pregnancy.

Surgical treatment of Fibroids

Mr Valentine Akande is a nationally recognised expert in the laparoscopic (key hole) removal of fibroids. This advanced technique known as laparoscopic myomectomy allows very quick recovery and in most cases only one night stay in hospital.

He lectures on this subject and undertakes masterclasses teaching other consultants how to perform this procedure.

Prior to deciding on whether surgery is appropriate for you, an ultrasound examination will be undertaken to assess your womb (uterus), and in some case further tests such as an MRI scan or Hysteroscopy may be required,

What is a Myomectomy

Myomectomy simply means having fibroids removed.  Fibroids are bundles of muscle fibres that grow in the womb.  They are almost always benign (non-cancerous). Fibroids increase the size of the womb. Some women have only single fibroid others could have many which could vary in size from 1cm and rarely are over 20cm. Myomectomy is generally performed in women who wish to preserve or  improve their fertility.

How is laparoscopic myomectomy preformed

The operation is performed under general anaesthetic and involves passing 3 or 4 small instruments into the abdomen through small (key hole) incisions each around 1-2cm long.  The operation usually takes between 1 – 3 hours depending on how many fibroids are being removed and where in the womb they are.  The incisions will usually be closed with dissolvable stitches.

Why have a laparoscopic (key-hole) myomectomy

There are several advantages, which include: a shorter hospital stay, quicker recovery, less pain after the operation, smaller scars on the skin and less blood loss. Occasionally it will not be possible to perform your surgery through a key hole operation and a open operation will be required. This will usually be though an incision along the ‘bikini-line’ like a Caesarean section scar, or rarely along the midline of your abdomen.

What are the possible complications associated with having a laparoscopic myomectomy

Removal of fibroids is usually straightforward but can occasionally result in complications. The likelihood would vary according to the complexity of your particular case. These include:

  • Blood vessels can be damaged causing significant bleeding and perhaps needing a blood transfusion.
  • There is a risk of damage to the bowel, bladder, ureter or other pelvic and abdominal organs. Such damage can often be repaired by keyhole surgery but on occasions require your abdomen to be opened through a much larger incision.
  • Scar tissue otherwise known as adhesions can occur after such surgery fibroid surgery.
  • Rarely, a hernia develops under the scar many weeks or months after the operation
  • In exceedingly rare circumstances a hysterectomy may be undertaken but only in situations where there is uncontrollable and excessive bleeding that is life threatening

Hospital Admission

On the day of your operation, Mr Akande and a Consultant Anaesthetist will see you.  You will give you information about your operation and ensure you are fit for surgery. You should have nothing to eat for at least six hours before your surgery and you can drink only water up to three hours before.

After the operation

When you awake you will have a drip with clear fluid running into your arm. This drip will be removed when you are able to eat and drink again. Depending on the complexity of your operation and how long it has taken you may have a catheter (tube) in your bladder to drain urine. In rare circumstances you blood level may have dropped as a result of the surgery and a blood transfusion may be needed.

Discharge home

You will usually be discharged home the day after your surgery. It is usual to be able to get back to normal activities within a week and work within 2 weeks.

Giving birth after laparoscopic myomectomy

Mr Akande will advise on what special precautions should be taken if you fall pregnant.  Generally you will be advised that you will need to give birth by caesarean section.

Video

Feedback from patient following Fibroid surgery

I have had considerable problems with a fibroid which had grown quite large over the last five years. The fibroid affected my fertility, resulting in three miscarriages. It caused me pain, discomfort and limited my physical activity due to the pressure it placed on my bladder.

I had seen several surgeons, prior to seeking out Mr Akande, none of which had offered me keyhole surgery. I was quite fearful of their proposed solution of three months hormonal treatment and an open myomectomy, with the accompanying side effects, risks and recovery period. I met with Mr Valentine Akande without much hope that he would propose a laparoscopic myomectomy (due to the size of my fibroid), but with a strong sense that he was a very skilled and dedicated surgeon. My confidence in him was inspired by the information I was able to find online regarding his speciality, qualifications and publications, and even a video of an operation, very similar to the one I knew I required, that he had previously conducted.

In my initial meeting with Mr Akande, it would be true to say, I was still very nervous of the various treatments available for my fibroid, but Mr Akande has a reassuring and straight forward manner and we were able to discuss my fears and preferences, regarding treatment, fully. Mr Akande then surprised and delighted me by proposing he remove this rather large fibroid via laparoscopic myomectomy and without the use of the hormone treatment I wished to avoid.

I was given all the information and time I needed to weigh up the risks and benefits of the proposed surgery, and when I decided to go ahead I was able to fix a date for surgery there and then, just four weeks away.

I was nervous on the morning of my admission, but I was prepared for surgery just an hour after arrival. Mr Akande and his team were all very calming and before I knew it, I was in recovery to discover that everything had gone well. Despite the fibroid proving to be larger than expected and surgery taking not three hours but four, Mr Akande had persevered with the keyhole surgery to give me the best outcome and shortest recovery time.

My scars are very small and neat, there have been no complications of any sort, and I was up and about right on schedule. In summary, I couldn’t be more pleased! I even have the option of more children open to me now. I only wish I had met Mr Akande several years ago and had the surgery all the sooner.

I would like to recommend him as skilled laparoscopic surgeon who takes great pride in the work he does, and who will go the extra mile when he meets a challenge. He also has a pleasant manner and great communication skills and this can really help to smooth the way if you are, like me, a nervous patient.

I am very grateful to Mr Akande, and I am so glad I put my faith in him.

Lara Perilli

 

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