Fibroids and Pregnancy
1) Can fibroids affect chances of getting pregnant ?
Fortunately, fibroids do not usually interfere with chances of getting pregnant Most of the fibroids are small and do not interfere with the cavity of the uterus or the fallopian tubes.
Submucous fibroids (those which encroach on the uterine cavity) can sometimes affect the process of implantation. This can lead to sub-fertility and sometimes early pregnancy loss.
Fibroids in the upper corner of the uterus (cornual region) can occasionally obstruct fallopian tubes and can be a cause of tubal factor subfertility. Similarly, very large fibroids and an enlarged uterine cavity can be a cause of not getting pregnant.
So in general, if the fibroids are small (smaller than 4cm) AND if the cavity is normal AND if the fallopian tubes are patent, there is no cause to worry.
2) What investigations can be carried out to ensure that pregnancy will not be affected ?
An ultrasound scan is usually all that is required. It can help in assessment of size, numbers and location of fibroids in relation to the uterine cavity and fallopian tubes.
Hycosy (HYstero-Salpingo COntrast SonographY) scan is where a contrast in injected into the uterine cavity and visualized on scan coming out of the fallopian tubes. This helps in more accurate assessment of uterine cavity and tubal patency.
Hysteroscopy is direct visualization of uterine cavity with an endoscope. This is a gold-standard for assessment and treatment of submucous fibroids to normalize the uterine cavity. This procedure is called as Trans Cervical Resection of Fibroid (TCRF) or Hysteroscopic Myomectomy.
Laparoscopy can help in assessment of the fibroids in relation to the fallopian tubes and also feasibility for Laparoscopic Myomectomy.
3) What are the risks in the antenatal period and during delivery ?
Fibroids usually cause no problems with pregnancy but can sometimes be associated with risks during antenatal period, labour and post-partum. Fibroids can increase the risk of early pregnancy loss and preterm birth especially if they are large or interfere with the uterine cavity (submucous fibroids).
During Pregnancy: Fibroids tend to increase in size with increased blood supply of pregnancy. This can lead to increased discomfort. Increase in size is also associated with ‘Red degeneration of Pregnancy’. This happens due to rapid increase in the size of fibroids where the central area of a fibroid does not get enough blood supply and undergoes ‘necrosis’. This is associated with pain and tenderness over the fibroid. Sometimes admission to the hospital and rest is required for pain relief, anti-inflammatory and supportive treatment.
In Labour and During Delivery: Fibroids in the lower part of the uterus can lead to malposition such as transverse lie or breech presentation necessitating Caesarean Section. Caesarean Section can sometimes be difficult and complex due to location of the fibroids.
Post-delivery : fibroids can interfere with contraction of the uterus leading to post-partum hemorrhage.
4) What can be done to optimize pregnancy outcome ?
A consultation with a gynecologist with an ultrasound is often what is required to make an assessment. If the fibroids are found to be large or within the uterine cavity, further assessment or removal of fibroid may be required before planning pregnancy . Fibroids may be associated with anemia and correction of iron levels may be required before embarking on pregnancy.
5) Are there any implications for pregnancy after surgery for fibroids ?
Resection of submucous fibroids ( Hysteroscopic Myomectomy) is associated with improved pregnancy outcome and there is no increase in risk during pregnancy or labor.Myomectomy operation can sometimes mean that a natural labor and delivery may not be safe especially if the fibroids were large and multiple. Your surgeon will be able to advise you if an Elective Caesarean Section is required.