Uterine Fibroids - Cause of Female Infertility | Infertility Treatments in India.
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Uterine Fibroids - Infertility Treatments in India. Uterine Fibroid is one of the factors associated with female factor infertility.
Uterine fibroids are benign (non-cancerous growth) in the muscular walls of the uterus. They are common in women of childbearing age. Fibroids can be very small or big, sometimes they are huge too.
There may be multiple fibroids in the uterus. Generally, Â fibroids do not cause any problem or symptoms but in some women, because of the location and size, they may cause pain and heavy bleeding during menses.
Fibroids are also associated with infertility in women of childbearing age. The formation and growth of uterine fibroids are estrogen and progesterone-dependent. Women in the age group of 25 years onwards and up to pre-menopause are more susceptible to fibroids, which may cause infertility. As more and more women are delaying pregnancy because of career goals, the chances of uterine fibroid being the cause of Infertility are increasing.
What are the factors responsible for Uterine fibroids:
The factors responsible for Uterine fibroids cannot be pinpointed. But the factors commonly associated with Uterine fibroids are the non-malignant mutation in a single cell, causing it to produce the abnormally larger amount of collagen and other proteins. Female hormones estrogen and progesterone play a role in the growth of uterine fibroids. Proteins common in bloodstream known as growth factors are also associated with formation of uterine fibroids.
Who are at risk of developing Uterine Fibroids:
postpubertal women are at risk of developing uterine fibroids, the risk is higher in the age group of 25 to 35 years.
- A hereditary medical condition, if someone's mother or sisters have developed uterine fibroids, they are at increased risk of developing them too.
- Women of African-American origin are at 2 to 5 times higher risk of developing uterine fibroids.
- Obesity is associated with the formation of uterine fibroids.
- deficiency in Vitamin-D may be one of the associated factors for uterine fibroids.
Diagnosis of Uterine Fibroid:
The treating Doctor may diagnose the uterine fibroid by taking the detailed history of the patient and by physical examination called bimanual physical examination. The treating doctor evaluates the shape and size of the uterus by inserting two fingers properly sterilized and gloved, into the cervix and surrounding pelvic regions while palpating the patient's abdomen above the pelvic bone with the other hand. Ultrasounds, hysteroscopy, hysterosalpingogram, CT Scans and MRI are confirmatory tests for Uterine fibroids and polyps.
Not all Uterine Fibroids or Polyps cause Female Infertility:
Not all uterine fibroids cause infertility. It is the location and size of uterine fibroid that makes the Infertility specialist suggest medical treatment for infertility. A uterine fibroid that may be blocking the passage of sperm to the fallopian tube to fertilize the ova needs to be treated. Uterine fibroids may also obstruct implantation of fertilized ova in the uterus to grow as an embryo. Large Uterine fibroids may cause miscarriage or natural termination of pregnancy and need to be treated.
Uterine fibroids can affect fertility in many ways. They may change the shape of the cervix and obstruct the flow of sperms in the uterus. Change in the shape and structure of the uterus hampers the movement of sperms and embryo. Even fallopian tubes may be blocked by the fibroids. They may have an impact on the size of the lining of the uterine cavity and reduced blood flow, thereby reducing the chances of a fertilized embryo to be implanted in the uterus.
The uterine fibroids which are supposed to have a big impact on fertility ( unless they are large and many in numbers) are the submucous type. Because submucous fibroids infiltrate the uterine cavity, they may cause an abnormality in the uterine cavity and cause infertility and miscarriage. Submucous fibroids are surgically removed to increase the chances of conception.
How Uterine Fibroids are treated:
The treatment of uterine fibroids depends on their location and symptoms. The treatment of uterine fibroid can be broadly classified into three categories.
Medical Intervention:
The medical management of Uterine fibroid involves using GnRH Analogue (Leuprolide acetate) and levonorgestrel-containing intrauterine device( Mirena). But they are not advised for a woman trying to conceive. Leuprolide and Mirena delay the ability to pursue attempts at conception.
Alternative treatments for fibroid:
Uterine artery embolization is a radiological alternative to surgery that involves placing a catheter into an artery in the leg and guiding the catheter via x-ray pictures to the arteries of the uterus. Once there, the catheter is used to deliver agents that block off these major blood vessels. The safety of this procedure in women desiring pregnancy has not been demonstrated yet and is discouraged by treating infertility specialists.
Surgical Interventions:
Surgical interventions are most advocated by infertility specialists for treatment of Uterine fibroid as they increase the chances of conception. Surgical removal of uterine fibroids are the most appropriate treatment for fibroids if the infertility specialists feel that they are the cause of infertility and recurring miscarriages,
Hysteroscopic myomectomy is most appropriate for infertility causing submucous fibroids of size as large as 4 to 5 centimeters.
Laparotomy, minimally invasive laparoscopy, and latest robot-assisted laparoscopy are also used as a minimally invasive surgical procedure for fibroid removal.
When should a woman start trying for conceiving after Fibroid treatment:
Different infertility specialist suggests a different time frame after myomectomy, most of the doctors suggest a time gap of six months for recovery of the uterus before woman start trying for conceiving. However, it is safe to start trying after three months.
