The incidence of fibroids (benign tumors in the muscle lining of the uterus) increases with age and in older reproductive age reaches 50% of patients.

Therefore, in recent years, it concerns a large percentage of women who have been forced to postpone their first pregnancy.

Their causes are generally unknown. Heredity, age, lifestyle and race all seem to play a role. Their number varies, from one to multiple scattered throughout the uterus.

The size also varies from a few centimeters to (rarely) 15-20. Their position in relation to the three linings of the uterus is very important for their possible involvement in female fertility.

1. Those that are under the outer lining of the uterus – the orogen – are called hypoorogens and are completely innocent.
2. Those located in the middle wall – the myometrium – are called mural and depending on their size may cause symptoms (bleeding) and infertility.
3. Finally, those located in the inner lining – the endometrium – are called submucosa and usually have a negative impact on fertility and the results of IVF. Mural and submucosal fibroids increase the risk of miscarriage by about 20%.

Mechanisms by which fibroids may adversely affect fertility and IVF outcome are as follows.

-The alteration of the architecture of the uterine cavity and therefore the receptivity (friendliness) of the endometrium caused by fibroids with their volume and the application of pressure.
-Disruption of normal blood flow (reduced blood flow) in the area where the fibroid is present and generally disturbed blood flow in the endometrium and myometrium.
-The disruption of the normal contractility of the uterus that affects the implantation of the embryo. In particular, there is an increase in the contractility of the myometrium, which makes implantation of the embryo difficult.
-Disruption of the normal production locally by the endometrium and myometrium of hormones and substances in general that are necessary for the embryo implantation process at the blastocyst stage.

Treatment of fibroids

The treatment of fibroids (removal) concerns only those in which there are serious reasons for their involvement in female fertility.
Intravaginal three-dimensional ultrasound, diagnostic hysteroscopy and, where necessary, magnetic resonance imaging help the attending physician in the decision to plan the surgical treatment.

Suborogenous fibroids are not associated with infertility and as benign asymptomatic tumors do not require surgical intervention and are simply monitored by ultrasound.

Mural fibroids that are distant from the endometrial cavity and do not press on it are a dilemma as to whether they should be removed. Size plays a role as many researchers recommend ablation for sizes larger than 3 cm.

It is the writer’s opinion that if all other known factors of infertility or IVF attempt failure have been ruled out, then surgical treatment of parietal fibroid as a possible cause should be performed.

Submucosal fibroids have a clear correlation with failure of embryo implantation and possible abortion, so they should be removed beforehand and definitely before attempting IVF.

The surgical treatment of fibroids is done with the help of endoscopic surgery.
The parietals are removed by laparoscopic surgery which guarantees minimal hospitalization, avoiding the creation of pelvic adhesions and immediate return to everyday life.

Today, most fibroids up to 12 cm are removed laparoscopically, and very rarely an open (laparotomy) surgery will be needed.
After surgery, a waiting period of 4-6 months is required for the strengthening of the postoperative scar or scars, if more than one fibroid is removed.

Submucosal fibroids are removed by hysteroscopic surgery and do not require hospitalization. Pregnancy can be attempted two months after the operation.

In conclusion, fibroids are benign uterine tumors that may in some cases interfere with fertility. The specialist gynecologist will judge the need for surgery or not after a thorough study and scientific documentation, and of course a discussion with the couple.