The best option for women with fibroids who want to preserve their fertility is myomectomy, a surgical procedure to remove the fibroids—not the uterus—through an incision in the abdomen. This surgery is also the best choice for women with a plethora of fibroids (15 to 20, for example) which are 7 cm or larger, or in a sensitive location, such as on top of a fallopian tube. Myomectomies are major surgery, and require a hospital stay of several days, and a recovery time of several weeks.
Depending on how many fibroids there are, and their size, some women may be able to choose a less invasive operation. Fibroids confined to the inside of the uterus, for instance, can be removed through the vagina with the aid of a hysteroscope, a telescope that goes into the uterus through the vagina and cervix. Women who have this procedure can go home the same day and return to normal activities in about 24 hours. Another advantage: the hysteroscope does not leave scars in the uterus, an important factor in fertility preservation. “This is a very elegant, minimally-invasive procedure,” says Ernst Bartsich, M.D., clinical associate professor of obstetrics and gynecology at the Weill Cornell Medical College in New York City. “But it can only be used for submucosal fibroids.”
Laparoscopy, in which fibroids are removed through small incisions in the navel, can be a good choice for women with only a few fibroids that are on the outside of the uterus and that aren’t larger than 6 cms, says Dr. Olive. After a laparoscopy women can leave the hospital the same day, but will need about three days to recover. The biggest concern with laparoscopy is that the uterus must be sewn back together with multiple layers of stitches to prevent it from rupturing during pregnancy, requiring a highly-skilled and experienced gynecologist.
Women who have had fibroid surgery can attempt getting pregnant about three months afterwards. And while the pregnancy will not be considered high-risk, the delivery will be monitored closely to make sure the uterus doesn’t rupture. Some physicians prefer not to have women who’ve undergone uterine surgery even attempt labor, and recommend scheduling a cesarean section instead.
For now, although there is still controversy over the best way to treat fibroids and maintain fertility, the best chance for success is for women to thoroughly research the issue on their own and get more than one medical opinion if necessary. “Not every physician feels comfortable offering the whole range of treatment options,” says Dr. Stewart of Boston's Brigham and Women’s Hospital. For more information, visit the National Uterine Fibroids Foundation at www.nuff.org; or check out the Center for Uterine Fibroids at www.fibroids.net. You can also order order a 117—page paperback, The Other Choice: A Comprehensive Guide for Women with Fibroids, by Ernst Bartsich and Sophie Bartsich at www.xlibris.com.
“Biologically speaking, we have no clue what causes fibroids,” says Carla Dionne. “Prevention is critical, and the whole issue of fertility is huge.”
A version of this article originally appeared in the Fall 2005 issue of Conceive Magazine.
Related Topics: Endometriosis and Fertility; Fertility Threats; Fibroids and Fertility; Infertility and PCOS