For women who find it difficult to get pregnant with their fibroids, removing the fibroids (Myomectomy) may improve the chances of pregnancy.
Other factors that influence pregnancy after a myomectomy would include:
A woman’s age at the time of myomectomy
- In a study of laparoscopic myomectomy conducted in France, it was found that women under the age of 35years with less than 3 years of infertility had the best chances of achieving pregnancy.
Number of fibroids removed
The location of the fibroids removed
Development of adhesions (scar tissue) after the fibroids have been removed
Once a Myomectomy has been performed and pregnancy is an immediate concern, there is no consensus as how long to wait before trying for pregnancy. It may be prudent to wait for between 3 and 6 months before trying for pregnancy to allow the wounds to heal
Some doctors depending on where the fibroids were located and how many there were may advice that women have a hysterosalpingogram (HSG), to check to see if the fallopian tubes are open. This is an X-ray test where dye is put through the "tubes" under X-ray guidance to see if the tubes are open.
If the fallopian tubes are open then pregnancy is advised either naturally for women who have normal regular periods or with medication for ovulation induction for women who have problems with ovulation.
If the fallopian tubes are not open then women would be advised to proceed to IVF.
Once pregnancy is achieved, most pregnancies will proceed as normal. The one risk of concern is RUPTURE of the WOMB (uterine rupture). This is where the scar from the operation “gives way”. This is a rare event with only 19 cases reported in literature after laparoscopic myomectomy. There are reports from as early as 17 weeks of pregnancy to term.
Rupture can occur before the onset of labour, so with any pain and or bleeding irrespective of how far in pregnancy women are they should consult their carers.
Some doctors advocate that all women who have had a myomectomy be delivered by Caesarean section.
A more sensible approach would be to review the operation notes from the operation, to take advice from the surgeon who performed the procedure and to monitor the pregnancy closely. If all goes well women are monitored in labour and if there are any concerns, prompt recourse to Caesarean section.
Of course as with all decisions for Caesarean section it would not be unreasonable for a woman to request delivery by Caesarean section after a myomectomy.