Infertility is defined as inability to conceive despite a regular unprotected sexual intercourse for one year. Both the partners are evaluated during the fertility treatment to know the problems and then a treatment plan is formulated. For the female partner, a transvaginal scan is done to look at the uterus, ovaries and other structures in the pelvis. If fibroid is present, then a note of number, size and location of each fibroid is noted.
Fibroid is a term that is used to describe growth in the muscle of the uterus . Fibroid is one of the most common problem of the female reproductive system. In majority of the women fibroids are asymptomatic and do not cause any symptoms .However depending upon its location , it may cause symptoms like excessive bleeding during periods or painful menstruation . Periods of heavy and prolonged bleeding may lead to anemia which causes generalised weakness, and lowered well being. Fibroids are estrogen dependent and generally regress after menopause
Fibroid may cause infertility depending upon its location and its size .Fibroids are classified into 8 types according to their location inside the uterus. Type 0 and 1 are entirely submucosal i.e. they are present inside the cavity entirely. They need to be removed before planning for pregnancy. Type 2 and 3 of fibroid are partly inside the wall of the uterus and partly project inside the cavity . These fibriods reduce the capability of baby to implant in the uterus . This may cause decrease in spontaneous fertility or early pregnancy loss. These fibroids should be removed . The treatment modality for these kinds of fibroid is hysteroscopic resection. It is a day care procedure which is done under General anaesthesia. There is no cut or stitch in this procedure and patient can go home the same day of the procedure.
When the fibroid is present in such a way that it is entirely in the wall of the uterus( type 4, 5 ) , then it is still debated whether they are a cause of infertility or abortions in a patient. The consensus is that such kinds of fibroids should be removed only when the distortion of the endometrial cavity is present. These fibroids are removed by laproscopic myomectomy. It is an operation under General anaesthesia where the camera and other instruments are placed into the abdominal cavity through a keyhole. The patient is discharged on the same day or next day. A gap of 8 to 12 weeks is suggested between the myomectomy and the next fertility procedure.
The fibroids which are present on the outside surface of the uterus( type 6, 7 and 8) do not impair fertility and do not need any intervention. If however a fibroid is present in such a location that it distorts the connection of the tube ( fallopian tube ) with the uterus, then it may block the tube and thus cause difficulty in conceiving.