Fibroid and Infertility

It is one of the most common diseases of women in their late 30s. When we have a sudden increase of menstrual blood, feeling of a lump in lower stomach, or backache, we come up with fibroid. About 30-40% of Korean women have a myoma whether they notice or not. However, not all the patients having a myoma need surgical treatment, but they take several different types of treatment depending on the size, location, and symptoms. Myoma surgery is probably one of the most frequently conducted surgeries in obstetrics & gynecology hospitals.

Since 1844 when myomectomy had first been conducted through laparotomy, plenty of methods of operation has been developed and are now being used in clinical procedures. Patients, however, still feel highly confused because there are lots of medical procedures for patients’ characteristics, and they do not know which procedure matches themselves. In effect, the doctors sometimes meet a patient who does not find a lump on lower stomach till it grows quite big considering it is just gaining weight, or sometimes a patient who comes to a hospital because of anemia from too much menstrual blood caused by a tiny myoma near the endometrium.

• Reason of Myoma
  There have been an enormous number of research to find the cause of myoma, but no one ever found a clear answer. Estrogen, progesterone, epidermal growth factor are considered as modulators of growth of myoma.
• Progression to malignant cancer
  Most of myomas are positive. The rate of malignant myoma found in operation is quite low: 0.1-1%.
  You should take care when you have abnormal bleeding or drastic increase of size of fibroid in 40-50s.
• Current treatment for myoma
  It is a part of internal treatment and downsizes a myoma by injecting GnRH-a to bring a patient to a condition similar to actual menopause. Since applying this method for a long time can lead to severe symptoms of osteoporosis or menopause, maximum 6 months of use are allowed. This treatment is known to be able to reduce 50% of myoma, however, the myoma return to its original size within 3 months after quitting the medicine. That means, this treatment needs to be limited to when a patient suffers from a serious anemia or cannot have an operation due to the other medical complications, or a lump is too big and needs to be decreased.
  For surgical methods, myomectomy using cervix for submucous myoma, myomectomy using pelviscope for myoma on myometrium or uterus serous membrane, myomectomy using pelviscope or hysterectomy of a part or the whole uterus for myoma on myometrium or uterus serous membrane is conducted. In the past, doctors extracted uterus through ventrotomy in most of cases, but many doctors are currently using pelviscope in operation; it creates less surgical scars and reduces hospitalization period.
  However trying to apply pelviscope to every operation for myoma might cause a worse outcome. In the case of patient with infertility, lots of experts say trying laparotomy is good for pregnancy or reduction of complications when there are several myomas, a myoma is close to uterus serous membrane or more than 7cm. Uterine artery embolization and myolysis using high frequency or heat are the examples of nonsurgical methods that doctors try.
  Hospitals that have expensive equipment and skillful specialists are trying them and some of them generated a good outcome. Myolysis is a method which locates a thread at the center of a myoma and necroses and downsizes a myoma by transvaginal ultrasound, and relieves the symptoms. Plenty of hospitals try this treatment since it does not need hospitalization nor make surgical scar. Also the experts suppose that continuous research on it will be conducted.
• Recurrence rate after removal of myoma
  It is a known fact that the young women show a higher rate of recurrence. Recurrence rate being reported is usually in a rage of 15-35%.
• Submucous fibroid drug delivery before operation
  When a fibroid intrudes into endometrium and fibroid endometrium is exposed during an operation, cesarean section is usually suggested to prevent hysterorrhexis in the next pregnancy.
  It depends on a decision of a doctor after operation. However the rate of hysterorrhexis after fibroid surgery is around 1%.
• Connection between a myoma and infertility
  During the period of pregnancy, myoma can become smaller, bigger, or just maintain its size. However it can lead to bleeding in early stage, hypogastric pain, premature labor, growth abnormality inside uterus, abruptio placentae, and massive intrapartum hemorrhage depending on its location.
• Adenomyosis and infertility
  Adenomyosis is a condition defined by a presence of endometrium on mesometrium and a similar disease with endometriosis. Sometimes it coexists with fibroid. Some patients show few symptoms, however, many patients have menstrual pain and a large amount of blood. Although it is almost unconnected to infertility, actual clinical experiences prove that many patients with adenomyosis have difficulties in being pregnancy. It can be partly diagnosed by ultrasound. The patients suffering from infertility and serious adenomyosis simultaneously are not likely to have a good result from in vitro fertilization.