31 Jul Fertility with myomas

By Reproclinic Editorial Committee

Myomas are benign, noncancerous tumors that originate in the uterus. Did you know that up to 30% of women can have fibroids at some point in their lives? Its appearance is quite frequent, especially during the fertile age.

These myomas are masses of muscle tissue that are generated in the uterus. Although you may believe that because of their location they can affect fertility, it does not have to be that way. In fact, it depends on various factors that affect fertility. In addition, myomas rarely develop into malignant tumors that pose significant risks to women.

Causes and detection of myomas

The reasons that can motivate the appearance of myoma’s in a woman’s uterus are not known for sure. However, in some cases they are caused by hormonal changes, such as those that occur during pregnancy, or for genetic reasons.

The doctor or gynecologist can detect the appearance of fibroids through various methods:

Pelvic ultrasound: It is the most reliable and common diagnostic method. It allows the gynecologist to measure the size of the myoma with greater precision and determine the number of myomas.

Magnetic resonance: it is not usually necessary, but in some specific cases it may be required.

Manual pelvic exam: The professional makes a manual touch of the pelvic area in search of alterations in the shape of the uterus. Not all myomas are easily detectable by this method, so transvaginal ultrasound is usually used to diagnose them.

Hysteroscopy: it consists of the direct exploration of the uterine cavity by means of the introduction of an optics through the vagina. Hysteroscopy can be diagnostic (to confirm whether a myoma detected on an ultrasound affects the uterine cavity or not) or therapeutic (to remove the myoma or myomas that affect the uterine cavity).

Types of myomas

There are three types of myomas based on their exact location within the uterus and the direction in which they grow: subserosal, intramural and submucosal.

Subserosal myomas: They are the most frequent. More than 50% of diagnosed myomas are subserosal, and are located on the outside of the uterus and grow into the abdominal cavity. They do not affect the uterine cavity.

Intramural myomas: They grow in the muscular wall of the uterus and remain in the thickness of the myometrium. They represent 40% of the cases.

Submucosal myomas: They are located under the surface of the uterine lining, growing into the uterus. It is the less frequent myoma (5%) but with greater symptoms and impact on fertility.

Do myomas affect fertility?

Subserosal fibroids do not usually affect the fertility, gestation or delivery of the woman who suffers, with the exception of them being large myomas.

Intramural myomas do not usually affect the uterine cavity, so they do not usually affect fertility, except in cases of large myomas that may have an impact on the uterine cavity.

Submucosal myomas, on the other hand, can directly relate to difficulties in conceiving. Given its location in the same endometrium, it can interfere with the implantation of the embryo or the entry of the ovule into the uterine cavity.

Does this mean that if I suffer from submucous fibroids I will not be able to get pregnant? Although it may be more related to fertility problems than the other two types, this does not necessarily mean that it can not be treated, as we will see below.

Treatment for myomas

Occasionally, the extraction of myomas from the uterus is not necessary. Although, just like with any intervention, it will always depend on the size and location of the uterus.

In other cases, extraction is recommended. Depending on the location, size and number of myomas, the intervention to remove them will be different.

When there is only one myoma or several that affect the uterine cavity (submucosal) it is usually done through a hysteroscopy, a procedure in which, with the help of a camera that is inserted into the uterus, removal is performed.

When there are several fibroids and different locations, they can also be removed with a laparoscopy, an operation in which fibroids are removed by introducing a small camera through the abdomen.

In cases of large fibroids, a laparotomy may be necessary.

The fact is that, each situation is different and requires an adequate diagnostic and therapeutic orientation. To ensure optimal treatment, the best option is always to consult with your gynecologist or a specialist in assisted reproduction. For any questions you may have, do not hesitate to contact us.