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Is surgery necessary to remove fibroids in the uterus?

Answered by: Dr B Shakuntala Baliga MD (AIIMS), FICOG

Professor and Senior Consultant Gynecologist & Colposcopist Mazumdar-Shaw Center for Cancer Research & Narayana Hrudayalaya Multispecialty Hospital, Bangalore

Q. My 36 years old wife has multiple fibroids in uterus. Her pelvic sonography details showed – uterus is retroverted, nongravid, bulky large sized measures transverse - 68 mm, AP - 59 mm, length - 100 mm, endometrium thickness is 9 mm. Intramural posterior wall fibroids seen measures 40 x 37 mm, 41 x 35 mm, anterior wall fibroids seen measures 34 x 30 mm, 18 x 23 mm, subserous fibroid of 14 x 14 mm. Her both the ovaries are normal - right ovary measures 22 x 16 mm and left ovary measures 20 x 18 mm. Multiple small follicles are seen over both her ovaries. Cul de sac is normal. No free fluid or blood seen in it. The doctor has suggested her laparoscopic surgery to remove the fibroids and he told us that my wife is not conceiving due to fibroids and surgery is the only option and it would take 3-4 cuts to clear all the fibroids. Is surgery necessary to remove the fibroids? Will it improve the chances of conception?

A.  Conception can take place only if the ovulation is taking place, the tubes are patent, your semen analysis is normal and postcoital test is normal. These tests (except may be tube testing) have to be done and should be normal before stating fibroids are cause of infertility. The number of fibroids present does require that they are removed, as during pregnancy these fibroids tend to grow and result in problems like abortion and preterm labour. Regarding laparoscopic surgery - you must get it done from a highly experienced person - otherwise, the "cuts" can give way during pregnancy leading to a life-threatening event called ruptured uterus.

Removal of fibroids does not guarantee pregnancy - sometimes the tubes can get blocked due to adhesion formation. Also, every patient has to give consent for removal of whole uterus if the bleeding during removal of fibroids is excessive.

A.  Conception can take place only if the ovulation is taking place, the tubes are patent, your semen analysis is normal and postcoital test is normal. These tests (except may be tube testing) have to be done and should be normal before stating fibroids are cause of infertility. The number of fibroids present does require that they are removed, as during pregnancy these fibroids tend to grow and result in problems like abortion and preterm labour. Regarding laparoscopic surgery - you must get it done from a highly experienced person - otherwise, the "cuts" can give way during pregnancy leading to a life-threatening event called ruptured uterus.

Removal of fibroids does not guarantee pregnancy - sometimes the tubes can get blocked due to adhesion formation. Also, every patient has to give consent for removal of whole uterus if the bleeding during removal of fibroids is excessive.

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