Uterine fibroids and infertility.

"Dear KnowYourV. 

I've been trying to get pregnant now for the past 3 years. During this time I have not had any problem getting pregnant, but once I'm pregnant I miscarry. This has happened twice and now I'm afraid to try again for fear I will just miscarry again. I recently had an ultrasound with my gynecologist and it showed that I have fibroids on my uterus. Is it true that I need to have the fibroids removed so I do not miscarry again? What does that mean, remove? Is it a big surgery and is there another way? I guess I just don't really understand about fibroids and why they would cause miscarriage."

These are good questions so let's see what's going on. Uterine fibroids (or myomas) are very common and usually genetically passed down. So if you have them then your mom, grandmother, aunts and other relatives probably had them as well. Maybe you heard stories about Aunt so & so who could never have a baby because she just had miscarriage after miscarriage, it could have been due to fibroids.

Fibroids are an abnormal growth of the uterine muscle. Fibroids are very firm, like a hard rubber ball or the inside of a golf ball. Individual fibroids can be as big as a large grapefruit (or larger) or as small as a pea. They can get so big that women can appear 5 months pregnant! Estrogen can make fibroids grow and enlarge (but once women are in menopause phase, as estrogen levels decrease, the fibroids can also reduce in size). Problems caused by fibroids are not helped by medication because the fibroids are not caused by hormone imbalance or spastic nerve problems.

Some fibroids are called “pedunculated” which means they hang off the uterus like an attachment, but are not grown into the muscle wall. These kind rarely interfere with menstrual cycles or implantation. It sounds like your fibroids are not pedunculated. When the fibroids have grown in as part of the uterine wall & push through into the endometrial cavity, the little embryo has lost its soft place to implant and grow. The fibroid, as mentioned earlier, is very firm and impenetrable. Therefore the embryo is like a little seed that tries to grow on a big rock or in a rock garden, it can only grow so much before it stops (and you miscarry).

That is why, yes, surgery to remove the fibroids is the very best option. Once they are removed, they are gone and do not grow back. Your body may grow new ones, but the ones that were removed will not grow back. It takes about 6 months for your uterus to heal after the surgery and we usually suggest that c-section is the safest way to deliver after this surgery. You are fortunate in that you have had no trouble getting pregnant, and the same should be true after this surgery. If fact, after surgery you are essentially cured, and can just go about living as you normally do, and when you become pregnant, contact your doctor to initiate your prenatal care.

I am often asked if this surgery can be done laproscopically. Yes, hysterectomies and removal of uterine fibroids can be done laproscopically. However, when we are removing fibroids with the intention of leaving the uterus for the purpose of future pregnancy it can be a very delicate procedure. During the surgery, care needs to be taken not to encroach on the fallopian tubes and to be gentle so that no intra-uterine scarring forms. Therefore these surgeries, called myomectomies, are usually done by making a small incision right above the pubic hairline (just like with c-sections). This allows for perfect visualization and care to be taken.

I know you will come through this without any problems, and please let me know the outcome.

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