Diagnosing Infertility
Fibroids
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A uterine fibroid, also known as a uterine leiomyoma or myoma, is a non-cancerous (benign) tumor that grows in or around the uterus. Uterine fibroids originate from the smooth muscle cells in the wall of the uterus and they are the most common benign tumors in females. It is estimated that 25% of all American women have fibroids, with African American women being 3 times more likely to have fibroids than Caucasian women.
Do Fibroids Affect Fertility?
According to the American Society for Reproductive Medicine, although fibroids are very common, they only cause about 3% of infertility. The fibroids that grow on the inside wall of the uterus can cause changes in the endometrial tissue, making it difficult for a fertilized egg to attach to the uterine wall. Fibroids that develop outside the uterus can interfere with pregnancy by pressing on or blocking the fallopian tubes, reducing the chance for the egg to travel down into the uterus.
How Are Fibroids Diagnosed?
Dr. Zoneraich and Dr. Larsen use 4 different diagnostic procedures to determine the presence, location and size of fibroids. Each patient does not undergo all 4 procedures.
- Ultrasound – a scan that uses echos from high frequency sound waves to create a picture of the pelvic organs
- Sonohysterography (saline sonography) - sonographic evaluation of the uterine wall and inner uterine cavity performed while filling the uterus with a very small amount of sterile fluid.
- Diagnostic Hysteroscopy – a procedure in which a narrow fiber-optic telescope (hysteroscope), is inserted into the uterine cavity to identify fibroids or other defects to endometrial lining
- MRI (Magnetic Resonance Image) - procedure that produces a picture by absorbing energy from specific, high frequency radio waves which can determine the presence and location of fibroids
Can Fibroids Be Treated?
Not all fibroids need to be treated. However, if the doctor determines that you have fibroids and they are interfering with your fertility, there are a number of treatment options. In general, only fibroids which effect or distort the inner lining of the uterus (endometrium) need to be addressed. In most cases, this can be accomplished through a straight-forward outpatient surgery called an operative hysteroscopy in which a telescope is inserted into the uterus through the vagina and cervix and instruments are used to remove the fibroid. In some cases, the problem fibroid may be much larger and mostly contained in the muscle wall of the uterus in which case it needs to be removed through the outside surface of the uterus. In most cases, you will be referred to your Ob/Gyn to undergo an abdominal myomectomy or in special circumstances, laparoscopic (with or without the use of a robot) myomectomy. In some of these cases, your Ob/Gyn may also utilize GnRH medications (lupron) that temporarily reduces the size of your fibroids prior to surgical removal.
In either case, the good news is that fibroids rarely impose more than a temporary speed bump in your path to achieving pregnancy.