Fibroids & Infertility

Question 1

Comment on the effect of the following types of fibroids on fertility:

• Submucosal
• Intramural
• Subserosal

Answer 1

Submucosal: negatively impact implantation, clinical pregnancy rate, miscarriage rate, live birth rate
Intramural: effect debated, may negatively impact implantation and clinical pregnancy rate, no apparent effect on miscarriage or live birth rate
Subserosal: no impact on fertility

Question 2

What would you counsel a woman with a 6 cm type 2 (< 50% intracavitary) fibroid about risks of hysteroscopic myomectomy?

Answer 2

With type 2 fibroid or fibroid > 5 cm, multiple procedures are likely to be necessary to completely resect the fibroid
Risk of intrauterine adhesions negatively affecting fertility

Question 3

What are the indications for abdominal myomectomy in an infertile patient?

Answer 3

Large (> 5 cm) type 2 fibroids

Any type 2 fibroid with < 1 cm between serosa & fibroid

Question 4

Your patient is concerned that if you attempt her myomectomy laparoscopically, you will not be able to resect the entire fibroid and she will not have the desired improvement in fertility. How would you counsel her?

Answer 4

Pregnancy rates are the same following laparoscopic versus abdominal myomectomy
Laparoscopic myomectomy is associated with decreased febrile morbidity, blood loss, and post-op stay

Question 5

List four contraindications to UAE.

Answer 5

Pregnant
Desire for future pregnancy
Clinical or radiologic findings suggestive of malignancy
Coagulopathy
Contrast anaphylaxis
Renal failure

Question 6

List two mechanisms by which UAE can negatively impact future fertility.

Answer 6

Damage to endometrium

Decrease ovarian reserve