Treatment of Tubal Infertility
In vitro fertilization and fertility tubal surgery
There are two treatment options for women to achieve pregnancies who have damaged fallopian tubes: fertility tubal surgery and IVF. Surgery and IVF do not compete as treatments but rather are complementary ways to achieve pregnancy.
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Fibroids are benign tumors of the uterine muscle (myometrium). They are very common in women, especially during a women's thirties and forties. Many times they are asymptomatic, but occasionally they can cause abnormal bleeding (very heavy periods), infertility or pressure symptoms from pressure on the bladder or the bowel. Occassionally they can get very large and form an abdominal mass. They very rarely cause pain unless they degenerate ( process of necrosis where the fibroid outgrows its blood supply).
Many women can live with their fibroids but it is recommended to remove them when they cause excessive bleeding (they are called subendometrial fibroids since they grow under the lining of the uterus) or infertility. The association of fibroids and infertility is not completlely proven, removal only is recommended depending on the size, location and abscence of other treatable infertility factors. There is suggestion that removing larger fibroids (5cm or more) or subendometrial ones improves IVF outcome.
The decission to remove fibroids is complex and requires expertise in the assessment of the problem. Hysteroscopy (viewing the uterine cavity with a telescope under local anesthesia) and ultrasound are important tools.
Fibroids can be removed with hysteroscopy (throug the cervix of the uterus) when they are largely located in the uterine cavity mainly. This is a specialized procedure with excellent results done as a daycare.
If fibroids are large or mainly located in the muscle of the uterus, an abdominal myomectomy, a surgery similar to a cesarean section is required. Pregnancy rates are roughly 65% afterwards, depending on the woman's age and other factors. Some women choose to preserve their uterus even when they are not trying to have a child. The surgery will restore the uterus to normal, unless the fibroids are many.
If the woman does not want to preserve her uterus a hysterectomy keeping the ovaries is the procedure of choice, it assures that there will be no further recurrence or periods. It can be done vaginally if the fibroids are small or abdominally if large.