Because of their great frequency in women, fibroids are particularly prevalent among women undergoing in vitro fertilization (IVF) therapy.
It is well acknowledged that fibroids are detrimental to IVF results and should be removed.
Uterine fibroids may impair a woman's capacity to carry a baby to term and fertility. This will be determined mostly by the kind of myoma, its extent, and its impact on the uterine cavity.
As a result, not all fibroids are withdrawn before assisted reproduction therapy begins. However, in certain circumstances, excision of fibroids is suggested to improve success chances.
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Do Uterine Fibroids Have an Impact on Fertility?
When uterine fibroids are discovered, one worry a woman of reproductive age may have is her ability to get pregnant.
First and foremost, women should understand that the presence of uterine fibroids doesn't necessarily prohibit them from becoming pregnant, even naturally.
Nevertheless, a fibroid may affect fertility because of one or more of the following factors:
- Blockage of the sperm's route to the fallopian tubes from the uterus, preventing conception. A blockage of the tubal ostium, or the orifices that link the uterus to the tubes, is also possible.
- Deformation or modification of the uterine cavity.
- Changes in uterine contractility.
- Changes in blood flow and vascularization.
As a result, in some women with fibroids, fertilization and embryo implantation may be hampered, potentially preventing pregnancy. Submucous fibroids are often related to reproductive capability impairment.
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In Vitro Fertilization and Myomas
Not every fibroid is removed before reproductive therapy, but fibroids are often removed in the following circumstances:
- When they have an effect on the uterine cavity.
- When they are rather large.
As a result, the expert must assess the issue individually, determining the kind of myoma the lady has, its size, quantity, and if the uterine cavity is impacted.
How Can Fibroids Get Removed?
Myomectomy refers to the surgical excision of uterine fibroids. The procedure may be performed through hysteroscopy, laparoscopy, or laparotomy, depending on the fibroids' size and location.
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Myomectomy for submucosal myomas is usually done hysteroscopically. The intervention for intramural and subserosal fibroids will be conducted by laparoscopy or laparotomy.
The gynecologist will advise the patient on how long they should wait following the myomectomy before attempting to conceive (naturally or with assisted reproduction).
Many additional fibroids treatment options exist, such as radiofrequency ablation or uterine artery embolization.
Separately, a hysterectomy is a more drastic option (removal of the uterus). Nevertheless, this approach to fibroids implies that the patient can no longer conceive.
As a result, some doctors say that hysterectomy should be avoided if possible, and more conservative therapy should be tried if the lady intends to become a mom.
However, this method is frequently employed if the lady has previously achieved her gestational goal.
It will be necessary to postpone conception following myomectomy to enable the uterine wall to recover. Because there is no myometrial incision following hysteroscopic myomectomy, this is relatively brief, but it must be long enough for the fibroid bed to recover.
However, following abdominal myomectomies, women are normally recommended to postpone pregnancy for at least three months, which causes delays in the planned IVF therapy.
This might be a problem for older women, especially those with low ovarian reserve. This delay may be avoided by undergoing IVF before myomectomy and storing the embryos for transfer after recovery.
One possible issue with this procedure is that fibroids may make access to the ovaries difficult.
If ovarian accessibility is compromised due to fibroids, some doctors advise surgery over IVF. They normally wait three months before starting IVF after surgery, but older women with diminished ovarian reserve, start IVF sooner and store embryos for later transfer.
