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 6 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 3 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.