UTERINE FIBROIDS

Listen from the best IVF specialist in Delhi NCR - Fibroids (or Leiomyomas) are benign (non-cancerous) growths of smooth muscle of the uterus and are a quite common condition in women. Almost 10-20% of all women in their twenties and thirties have uterine fibroids. In later decades this incidence can be as high as 40-50%! Fibroids are more commonly seen in women having Infertility. Also, women with fibroids have more difficulty in conceiving than those without fibroids.

Risk factors for development of fibroids

• Late marriages or not bearing a pregnancy till thirties can lead to Fibroid development
• Not breast feeding your baby can lead to higher chances of developing a fibroid later on
• Exposure to environmental toxins like Dioxins, certain medicines, Estrogen exposure
• Genetic predisposition (hereditary influence)
• Most commonly there is no discernible cause and Fibroids develop on their own without any reason

Symptoms of Uterine Fibroids

The symptoms of having a single or multiple Fibroids in uterus depends a lot on the number, size, site (location), type and quality of fibroid. Fibroids are generally divided into three categories:

1. Those that are closer to the outer wall are called Subserosal and usually cause no Symptoms. However if these are pedunculate (attached with a thin stalk) they can sometimes twist leading to intense, sudden pain because of stoppage of blood supply. Again, if they go and ‘wander’ in the abdomen they can cause Infertility by Fallopian tube blockage or even Intestinal obstruction.

2. Those that mostly lie within the Uterine wall and do not protrude inside or outside are called Intramural Fibroids. Although considered to be the most innocuous of all fibroids, Intra-mural fibroids can sometimes enlarge to great sizes (more than 5-8 cms) and cause pressure effects. These fibroids can cause abdominal cramps and excessive bleeding (menorrhagia). If they press upon the bowel or bladder they can cause constipation/dysuria respectively.

3. The fibroids that lie close to the endometrial lining are called Submucosal Fibroids and they are the most dangerous or relevant fibroids as far as Fertility is concerned. Apart from irregular menstrual periods and excessive bleeding, these fibroids invariably cause Infertility due to the pressure effects on the endometrium and also by hindering embryo implantation. Even if a woman conceives with submucosal fibroids, there is increased chances of a Miscarriage when these fibroids are present.

Complications caused by Uterine Fibroids:

• Menorrhagia (excessive menstrual bleeding) - leading to fatigue, weakness and anaemia in the long run
• Dysmenorrhea (painful periods)
• Abdominal pain, bowel or bladder problems - depending on the size and site of fibroids
• Problems in pregnancy - Fibroids can cause miscarriages, premature births and obstructed labor in pregnancy
• Leiomyosarcoma - this is cancerous changes in a Fibroid and is very very rare
• Infertility - this is the most important and a common symptom. As described above, the submucosal fibroids that are close to the endometrial lining are most responsible for this to occur.
`

Diagnosis of Uterine Fibroids

At Janini IVF, the best ivf treatment center in Delhi, first you will undergo a thorough history taking and meticulous physical examination. All the salient points about your past investigation reports, previous treatment taken and other relevant facts will be noted. Further tests may include the following :-

 

Treatment of Uterine Fibroids

If you have problems with Infertility or some doctor have told you have uterine Fibroids Janini IVF is the right place for you. Not only Janini IVF, the best Azoospermia Treatment center in Delhi NCR, has the best IVF and Infertility treatment success in Delhi, it is also a trusted name with utmost scientific excellence and complete transparency for patients at every step of the way.

The line of management of Uterine Fibroids has to be devised keeping in mind certain vital characteristics of not just the Fibroids but also the patient and the couple’s preferences. We at Janini IVF will sum up an individualised treatment protocol for your fibroids considering the following parameters:-

• Your age and duration of infertility
• Other symptoms that you may have
• Your husband’s semen analysis and other reports
• Size, site and type of fibroids
• Tolerance for operative procedures versus medications
• Chances of progression of the disease

Depending on these factors, we will surmise a tailor-made solution to your condition to expedite your Fertility treatment. You might need a Laparoscopic surgery, might need some drugs, or you might do away with Fibroid treatment altogether depending on the location and size of fibroids. Not all fibroids need treatment and it is important for you to understand this. If at all removal of one or more fibroids is necessary, the following excellent therapeutic options are available at Janini IVF :-

• Removal of Fibroids through Laparoscopy - This procedure of surgical removal of fibroids is called Laparoscopic Myomectomy and is now the most preferred way to remove fibroids. Open surgery is not preferred anymore as Laparoscopy has many advantages. These days with experienced surgeons even huge masses can be removed via Laparoscopy.
• Hysteroscopy - If the fibroid is within the uterine cavity, or majority of the fibroid mass is impinging inside the uterus, then it is best to remove it via Hysteroscopy. This procedure is called Hysteroscopic Myomectomy and is done by an experienced surgeon via Resectoscope. It is best you choose an experienced surgeon like Dr Dalal who has performed thousands of such procedures as these procedures are quite skilful and not safe in novice hands.
• Laparo-Hysteroscopy - Often times we need to have both Laparoscopy and Hysteroscopy done simultaneously so that we can better approach all the Fibroids and remove them all in an efficient fashion.
• MRgFUS - Magnetic Resonance guided Focused Ultrasound: This basically involves trying to dissolve the fibroid tissue by Ultrasonic heat waves. Although acclaimed by a few clinicians, this treatment modality is yet to stand the test of time.
• Laser ablation - here one tries to coagulate fibroid tissue using LASER beams in laparoscopy instead of removing the fibroid. This method is expensive and not preferred.
• Uterine Artery Embolisation - Considered as a minimally invasive technique, UAE involves instilling certain substances in the Uterine Artery in order to block it so that the nourishment to the Fibroid is reduced and it shrinks. Although this could be done in some patients, it is avoidable in patients wanting to conceive as we don’t know the effects of this procedure on the health of future pregnancies.
• Oral medications - like Aromatase inhibitors, SPRMs like Uripristal, Mifepristone, NSAIDS, GnRH agonist depots, etc have wide range of side effects and they are suitable for specific set of patient groups. For all patients awaiting fertility treatment or wanting to conceive in the future, this treatment is avoidable.
• In some conditions, it is best to not do anything for the Fibroids, This is particularly relevant for subserosal and small intra-mural fibroids that do not disturb fertility. In this case it is best to proceed with IVF leaving the fibroid as it is.
• Please consult a good fertility specialist before embarking on the right treatment for you.

Best treatment for Fibroids - Janini IVF

As surmised above, the right treatment for Uterine Fibroids is case specific and patient specific. The treatment protocol should take into consideration the holistic picture of Fibroid characteristics along with patient profile. In many instances Fibroids do not need any treatment. If you have a problem of Infertility or if you are told to have Uterine Fibroids you should avail a consultation at Janini IVF. At Janini IVF, the best fertility center in Delhi, we treat the patient - not the Ultrasound report !!