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Fibroids and infertility

Mr Amit Shah, Mr Anil Gudi & Prof Homburg

Fibroids are non-malignant tumours of the uterus. They are very common over the age of 30 and usually appear in groups rather than singly making the uterus large and bulky. Despite this they may go completely unnoticed. When they do cause problems these usually take the form of heavy periods. The presence of fibroids has little impact on reproductive function. This depends on their size, number and, most importantly, on their position.

Fibroids on the outer side of the uterus (subserous) or within the muscular wall (intramural), rarely interfere with reproductive function. However, it is those that bulge into the cavity of the uterus (submucous) that may cause a problem. They may interfere with the implantation of the embryo which chooses to land on a part of the internal lining of the uterus which has been made inhospitable due to the presence of a fibroid. More often, this location of fibroids may cause a miscarriage rather than a problem to conceive.

As far as a problem of infertility is concerned, subserous fibroids should be left well alone. The majority of experts would say the same regarding fibroids in the wall of the uterus that do not distort the cavity of the uterus. However, fibroids in the uterine cavity that are thought to be causing a problem of infertility or repeated miscarriages should be removed. This can usually be performed using a procedure, hysteroscopy, which is performed through the vagina and cervix with instruments devised specially for the purpose.

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