Tanmayee and her husband have tried for a year to get pregnant. When she went for investigations, she was found to have a large fibroid on the uterine wall. Does she really require surgery to conceive?
Tanisha has been married for six months. When she went for confirmation of pregnancy, she was surprised to find that she also had a fibroid. She and her husband were devastated when her obstetrician told her to abort the baby. “You may miscarry or you will have complications in pregnancy,” she was told.
Actually, Tanisha does not need to abort the pregnancy just because she has a fibroid.
Fibroids and fertility
Up to 20-30 per cent of women in the child-bearing age group will have fibroids. In spite of this high incidence of fibroids, there is not much evidence that they contribute significantly to infertility. A scientific study showed that only submucous fibroids had a negative impact on fertility.
Submucous fibroids are fibroids that lie very close to the inner lining of the uterus or actually inside the uterine cavity. When a large uterine fibroid pushes against the uterine cavity, causing a change in the shape of the uterine cavity, it may lead to infertility.
A good quality ultrasound scan will be able to define the position of the fibroid. A 3-D ultrasound is particularly useful in this situation. When the submucous fibroid is lying inside the cavity, it can be removed by hysteroscopy.
In this procedure, a lighted scope is inserted through the vagina into the cervix (mouth of the uterus) and the uterine cavity is entered without any surgical cut. The fibroid is removed and the normal shape of the uterine cavity is restored.
Even very large fibroids may not have any effect on fertility. On the other hand, when a large fibroid is removed by surgery, it may be hazardous to the subsequent pregnancy.
When the surgical incision goes deep into the uterine wall, there is a small chance that the scar may give way in the next pregnancy.
If you have had a fibroid removed surgically, and are planning a pregnancy, make sure that your gynaecologist tells you whether the uterine cavity was entered during surgery. A caesarean section may have to be scheduled three weeks before the due date, to prevent rupture of the uterine scar.
Fibroids and recurrent miscarriage
A fibroid that bulges into the uterine cavity may lead to recurrent miscarriage. The embryo may not be able to implant into the uterine cavity and this may result in a miscarriage.
If all other causes of miscarriage are ruled out, removing the submucous fibroid may result in a successful pregnancy.
Fibroids and pregnancy Since fibroids are so common, one to two in 100 pregnant women will have fibroids. Luckily, only one in 500 pregnant women will need to be admitted for complications related to a fibroid.
What happens to fibroids in pregnancy?
Fibroids respond differently in individual women and it is difficult to predict their growth. Most small fibroids will remain unchanged or may grow slightly. The large fibroids usually remain unchanged or may become smaller. After the delivery, as the uterus shrinks, most fibroids will shrink along with it.
Can fibroids harm the baby? However large the fibroid, it will not hurt the baby or cause deformities. The presence of fibroids is not an indication to abort the pregnancy.
Complications due to fibroids
Rarely, the fibroid may grow so fast that it may cause pain and low fever. This only requires rest and painkillers and will subside in a few days. Rarely, large fibroids may result in premature delivery. Occasionally, the fibroid may be placed low on the uterus, close to the cervix (mouth of the uterus).
In this case, the fibroid may come in the way of a normal vaginal delivery and may require a caesarean section. However, most women with fibroids in pregnancy will be able to have a vaginal delivery without any problems.
Is surgery required if fibroids are diagnosed before pregnancy?
Sometimes, a young woman may be diagnosed to have a fibroid before she has become pregnant. In the majority of these women, no surgery is required. It is better to avoid a scar on the uterus before a pregnancy. Rarely, if the fibroid is abnormally large and is physically uncomfortable, surgery may be recommended.
The treatment options for fibroids will be discussed in my next column.
The author is an obstetrician and gynaecologist practising in Chennai and has written the book ‘Passport to a Healthy Pregnancy'.
www.passport2health.in
