RANZCOG - fibroids in infertility

Question 1

what are the 3 types of fibroids?

Answer 1

subserosal - on the outside
intramural - in the body
submucosal - in the cavity

Question 2

What 2 factors about fibroids may cause them to impact on fertility?

Answer 2

The number and size of the fibroids

their position - submucosal, intramural, subserosal

Question 3

If the position of the fibroid is an important factor in whether or not fertility is impacted, how can you assess this?

Answer 3

• hysterosalpinography and TV USS are not sensitive tools for this
• MRI gold standard imaging
• hysteroscopy diagnostic imaging
  note hysterosocpy may underestimate SM fibroid due to the hydrostatic pressure from hysteroscopy

Question 4

Position wise - which fibroids are most associated with sub fertility and miscarriage?

Answer 4

• submucosal
• possibly intramural
• NOT subserosal

Question 5

What are the 3 indications for myomectomy in infertile women?

Answer 5

• Submucosal fibroid + undergoing ART
• infertile women with HMB or symptoms of fibroid (more cos symptoms justify the intervention)
• multiple failed ART cycles + presence of SM fibroids

Question 6

There are 3 alternative approaches to the management of fibroids - what are they?

Answer 6

• uterine artery embolisation
• radio-frequency ablation
• MRgFUS (MRI guided focussed USS surgery)

Question 7

What is the role of medical management for women with fibroids who desire fertility?

Answer 7

• delays effort to conceive
• can use GnRH analogues pre operatively to correct anaemia or short term reduction in fibroid volume

the use of ulipristal acetate is not recommended due to the risk of Adverse side effects