Fibroids are the most common tumor of the womb in women of reproductive age.
In some women they can be responsible for either menstrual period problems or problems with fertility.
Fibroids cause infertility mainly by distortion of the cavity of the womb and sometimes by mechanical obstruction of the fallopian tubes.
When fibroids cause problems during reproductive life some women may be advised to have their fibroids removed.
Fibroid removal is usually achieved by either
1. Traditional open myomectomy
2. Hysteroscopic myomectomy
3. Laparoscopic myomectomy.
Adhesions “scar tissue” are a consequence of healing, where tissues that are close to each other during the healing process get stuck together as a consequence of the healing process.
Whatever method is used to remove the fibroids adhesion formation may be a consequence of surgery.
The adhesions themselves can be significant complications in women who are seeking to improve fertility.
The adhesions become significant if
1. They form within the cavity of the womb (intrauterine adhesions) or
2. If they form on the outside of the womb, distorting the relationship between the fallopian tubes, the womb and the ovaries. This in itself can lead to infertility
After laparoscopic or open myomectomy adhesions can form inside the cavity of the womb (intra-uterine adhesions) if the cavity of the womb is breached during surgery. This on occasion is unavoidable. Up to 30% of women in whom the cavity of the womb is breached during myomectomy will develop intrauterine adhesions.
After hysteroscopic surgery for fibroids between 10-30% of patients will develop intrauterine adhesions.
This risk of developing adhesions increases with the size of the fibroids and the number of fibroids removed particularly if the fibroids are on opposite (apposing) sides of the inside of the womb. One scientific study showed that after one fibroid resection 31% of women developed adhesions and this rose to 45% when 2 fibroids were removed.
Surgeons use various methods to try to prevent adhesions during hysteroscopic surgery but none of these methods carry a guarantee of avoiding adhesion formation.
For women requiring fertility the best method of managing adhesion formation is early identification. Thus after surgery your doctor may advise a check up hysteroscopy to diagnose adhesions and to possibly divide them if they have formed. The same advice would go to women who have had laparoscopic or open surgery for their fibroids in whom the uterine cavity has been breached.
Adhesions after uterine artery embolization
Uterine artery embolization is another conservative method used to treat symptomatic uterine fibroids.
Though there are reports of successful pregnancies after uterine artery embolization it is not the treatment of choice for women who want to retain fertility.
However under certain circumstances it may be offered. In women who need to have uterine artery embolization for the treatment of their fibroids up to 14% will develop intrauterine adhesions.
In some women they can be responsible for either menstrual period problems or problems with fertility.
Fibroids cause infertility mainly by distortion of the cavity of the womb and sometimes by mechanical obstruction of the fallopian tubes.
When fibroids cause problems during reproductive life some women may be advised to have their fibroids removed.
Fibroid removal is usually achieved by either
1. Traditional open myomectomy
2. Hysteroscopic myomectomy
3. Laparoscopic myomectomy.
Adhesions “scar tissue” are a consequence of healing, where tissues that are close to each other during the healing process get stuck together as a consequence of the healing process.
Whatever method is used to remove the fibroids adhesion formation may be a consequence of surgery.
The adhesions themselves can be significant complications in women who are seeking to improve fertility.
The adhesions become significant if
1. They form within the cavity of the womb (intrauterine adhesions) or
2. If they form on the outside of the womb, distorting the relationship between the fallopian tubes, the womb and the ovaries. This in itself can lead to infertility
After laparoscopic or open myomectomy adhesions can form inside the cavity of the womb (intra-uterine adhesions) if the cavity of the womb is breached during surgery. This on occasion is unavoidable. Up to 30% of women in whom the cavity of the womb is breached during myomectomy will develop intrauterine adhesions.
After hysteroscopic surgery for fibroids between 10-30% of patients will develop intrauterine adhesions.
This risk of developing adhesions increases with the size of the fibroids and the number of fibroids removed particularly if the fibroids are on opposite (apposing) sides of the inside of the womb. One scientific study showed that after one fibroid resection 31% of women developed adhesions and this rose to 45% when 2 fibroids were removed.
Surgeons use various methods to try to prevent adhesions during hysteroscopic surgery but none of these methods carry a guarantee of avoiding adhesion formation.
For women requiring fertility the best method of managing adhesion formation is early identification. Thus after surgery your doctor may advise a check up hysteroscopy to diagnose adhesions and to possibly divide them if they have formed. The same advice would go to women who have had laparoscopic or open surgery for their fibroids in whom the uterine cavity has been breached.
Adhesions after uterine artery embolization
Uterine artery embolization is another conservative method used to treat symptomatic uterine fibroids.
Though there are reports of successful pregnancies after uterine artery embolization it is not the treatment of choice for women who want to retain fertility.
However under certain circumstances it may be offered. In women who need to have uterine artery embolization for the treatment of their fibroids up to 14% will develop intrauterine adhesions.
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