When Can I Get Pregnant After Myoma Surgery? Pregnancy after removal of uterine fibroids. The impact of surgery on reproductive function

Article last updated 07.12.2019

Uterine fibroids are often diagnosed in women of childbearing age. At the initial stages, doctors try to cure the neoplasm with the help of conservative, mainly hormonal therapy. But in cases where a benign tumor grows rapidly and poses a threat to the health of the patient, the only treatment option is surgical removal of fibroids. It is at this moment that women who want to have children ask themselves the question: “Is pregnancy possible after removal of uterine fibroids?”.

Basically, the tumor is localized in the smooth muscle layer of the reproductive organ, in rare cases, the pathological focus can be located in the cervix. According to medical statistics, more than half of women diagnosed with uterine fibroids have a high chance of becoming pregnant and enduring the entire period of pregnancy and childbirth without complications.

The success of conception depends on the location and size of the neoplasm. There are cases when the tumor blocks the lumen of the fallopian tubes and makes it impossible to attach the ovum to the uterine cavity. But even if a woman managed to get pregnant, there is a high probability of her spontaneous interruption at the earliest possible date. It should not be forgotten that during pregnancy a serious hormonal restructuring occurs in the female body, so it is almost impossible to predict in advance how the fibroid will behave.

The development of the disease during pregnancy is very unpredictable and dual in nature:
In some cases, myomatous nodes under the influence of a changed hormonal background of a woman not only decrease in size, but can also completely dissolve without any medical intervention;
The reverse side of the coin is the intensive uncontrolled growth of a benign tumor under the influence of increased hormone production, which in the future may cause spontaneous abortion.

Therefore, doctors are faced with a very difficult dilemma: allow the patient to become pregnant with fibroids, or first remove the tumor, and then plan for conception. In the event that specialists are inclined to preliminary surgical intervention, then after a complete examination, the doctor must choose the optimal method for removing fibroids in each case. Whether it is possible to get pregnant after removal of fibroids depends on many factors, so no doctor will give a 100% guarantee.

Fibroids Removal Methods

Today, there are various methods for performing myomectomy. Choosing the way in which the surgical intervention will be performed, the doctor takes into account the growth rate and size of the node, its localization and other clinically important parameters. The most popular methods of myomectomy are:

Hysteroscopic removal- is used in women with a submucosal location of the myomatous node. The operation is performed using a hysteroscope through the cervix. This method of removal has clear advantages for those patients who wish to become pregnant in the near future. Surgery is performed under general anesthesia, the duration of an uncomplicated operation rarely exceeds 15 minutes. The tumor can be removed mechanically, laser, electrosurgical way. The advantages of hysteroscopy are minimal trauma, painlessness, quick rehabilitation.
Laparoscopic removal- is used when a sufficiently large amount of surgical treatment is necessary and in cases where there is a question of the complete removal of the reproductive organ with or without appendages. After laparoscopic removal of myomatous nodes, pregnancy occurs more often than with laparotomy (the open method of removal is more aggressive and traumatic). Among the advantages of this method, one can note the easy and rapid course of the postoperative period.

Arterial embolization method- is based on the overlap of the lumen of the vessels that feed the myoma, by introducing a special sclerosing substance into them. Due to the overlap of the lumen of the vascular network, the blood supply to the pathological area is disturbed and subsequent necrotization (tumor death) is observed. This technique is innovative, so it is too early to judge the consequences and complications. But experts consider the UAE method one of the safest for those who want to get pregnant. Patient reviews are mostly positive, therefore, despite the high cost of this procedure, many women choose this particular method of removing fibroids.

Complications affecting pregnancy

Despite the fact that most gynecologists stubbornly insist on the removal of fibroids, even in nulliparous patients, it is still worth carefully weighing all the risks. Of course, the widely used hystero- and laparoscopic operations are less traumatic and do not pose a threat to life, but at the same time they do not give a full guarantee that a woman will be able to have children in the future.

Any surgical intervention can adversely affect a future pregnancy.

Therefore, when it will be possible to plan conception, only the attending physician determines.

Possible complications:

ectopic pregnancy;
spontaneous abortions at different stages of pregnancy;
the formation of adhesions;
relapses of the disease;

massive uterine bleeding during childbirth;
damage to the uterus during childbirth in the area of the postoperative scar (up to rupture of the organ);
anomalies in the development of the fetus associated with a violation of the trophism of the uterus due to nodular formations.

rehabilitation period

In order to increase the chance of getting pregnant and giving birth to a healthy baby after a conservative myomectomy, a woman must responsibly follow the rules of rehabilitation.

In the early days, you must follow a therapeutic diet. The use of foods rich in fiber is the first prevention of constipation;
Completely exclude physical activity, which puts a load on the organs of the small pelvis and abdominal cavity;
Be sure to wear a specialized, correctly sized bandage for at least a month;
It is advisable to engage in exercise therapy groups.

It is important to regularly visit a gynecologist who will monitor the condition of the pelvic organs and abdominal cavity, and help plan pregnancy after treatment for uterine fibroids.

Chances of conception after removal of fibroids

The possibility of getting pregnant after removal of fibroids directly depends on the amount of surgical treatment performed. Also important is the state of the reproductive system and the hormonal background of a woman, both in the early and late postoperative periods. Strict adherence to the prescriptions and recommendations of the attending physician will help to properly plan pregnancy after myomectomy and give birth to a healthy baby.

After successful surgical treatment of fibroids, the chances of getting pregnant are quite high. But it is important not only to conceive, but also to endure a child. In order for pregnancy and childbirth to pass without complications, doctors recommend planning conception no earlier than a year after the surgical removal of fibroids, and after a complex band surgery you can get pregnant only after 2 years. Motherhood after removal of fibroids is quite real, more than 50% of treated women successfully give birth to healthy children.

26.04.2017

Myoma is a benign tumor in the uterus associated with an abnormal increase in muscle tissue.

Pathology occupies a leading position in the list of the most common female diseases of the genital area.

For this reason, a large part of the "strong" half of humanity is interested in the question of the reality of pregnancy after removal of uterine fibroids. The good quality of pathological processes in the uterus allows doctors to delay surgery as much as possible and try to cope with the problem with conservative methods.

But the rapid increase in the volume of the muscles of the uterine body often forces doctors to resort to surgical intervention, the scale of which is directly determined by the stage of the process and the area of its localization.

The effect of a tumor on a woman's reproductive performance

It is the muscular layer of the uterus in the vast majority of cases, about 85%, that is the location of the benign tumor in question, and only occasionally (15% of patients) does the disease affect the uterine cervix. The process of conception does not pose any problems for most of the patients, in addition, they feel great during all 9 months of pregnancy.

The decisive factor in this case is the localization of pathology. It happens that overgrown formations block the fallopian tubes or completely prevent the attachment of the fetal testicle in the uterine cavity. The probability of premature termination of pregnancy in such patients is higher in comparison with healthy women.

It is necessary to take into account the absolute unpredictability of the considered pathology during pregnancy. At this time, the transforming hormonal background in a woman becomes the main thing.

In medical practice, there have been cases when the uterus was completely cleared of muscle nodes due to the effects of sex hormones. No recurrence of tumors was observed after that. But mostly there is a rapid growth of muscles, leading to the risk of abortion, and sometimes to damage to the uterus itself.

Moreover, the growth of the pathology is fraught with complications during the birth itself, since this process, even if it is benign, has a negative effect on the contractile functionality of the uterus, and a caesarean section is often associated with bleeding that can provoke the removal of the main reproductive organ, which is so important for any woman.

As a result, it turns out that the doctor is faced with a rather difficult dilemma: to immediately appoint a patient with such a diagnosis of sanitation or to allow pregnancy.

What operations are offered by modern clinics for the removal of myomatous nodes

In case of ineffectiveness of conservative therapy, the doctor usually decides to do a myomectomy, in other words, a resection of the tumor itself, which avoids amputation of the uterus itself. Today, there are not so few methods for carrying out this operation:

Laparoscopy. If extirpation of the uterine appendages is required, or if the volume of the forthcoming surgical intervention is significant, then the doctor should stop his choice on this method of treatment. Today, laparoscopy is used more often than other operations by medical centers, because of this it is considered the most “adjusted” and safest. The use of specialized techniques makes it possible to minimize the postoperative period and gives the patient a chance to give birth in the future with uterine-sparing surgery. The probability of getting pregnant after such treatment is much higher than with other types of operations.

Hysteroscopy. This type of operation is chosen in case of diagnosing a submucosal node in a woman. The doctor operates the uterine cavity through a special apparatus through the cervix. The whole procedure is carried out under general anesthesia without any mechanical effect on the patient's skin, in other words, after the operation she will not have scars. Basically, surgeons perform hysteroscopy mechanically, however, if necessary, it is possible to connect both an electrosurgical removal method and a laser. At the same time, regardless of the method of removal, the operation itself, technically, is nothing complicated and takes a maximum of 15 minutes in time.

arterial embolization. The safest method, characterized by minimal physical intervention in the body when removing the tumor or its nodes. It is carried out by filling the uterus (with all arteries, veins, appendages) with a special substance that blocks the vessels in a specific area, which allows you to “turn off” the replenishment of the neoplasm localization zone. Deprived of nourishment in the form of blood, the tumor gradually shrinks in size and after some time completely dies off.

What is the danger of myomectomy for future pregnancy

Basically, today's obstetrician-gynecologists, when diagnosing an intrauterine tumor in a patient, prefer to treat according to the first two treatment methods described above.

This is due to the guaranteed removal of the neoplasm, as well as the ability to control the likelihood of malignancy of the procedure. But, for a planned future pregnancy, these methods are quite dangerous.

According to world statistics, only 50% of women who underwent such an operation were able to conceive a child and then give birth. The figure is very symbolic and thought provoking. It is impossible to remain silent about other dangers that lie in wait for expectant mothers who decide to have an operation:

most importantly, with hysteroscopy and laparoscopy, there is a rather significant risk of the occurrence and further progression of the adhesive process, which can disrupt the normal development of a precious pregnancy, and this does not even require the presence of nodes on the uterus;

none of these methods guarantees that the disease has receded for good. In 15 - 18% of the operated patients, re-formation of foci was noted;

complications during childbirth are not uncommon. Intrauterine bleeding and ruptures along the scar are still almost the most dangerous obstetric problems;

it should be borne in mind that all interventions in the female genital area can cause the following complications: ectopic pregnancy, abnormal fetal development due to destabilization of the uterine blood supply, miscarriages.

In addition to the dangers listed above, it is very important to consider such points as:

the number of scars on the operated uterus;
whether an autopsy was done on the operated organ;
the risk of proliferation of scar tissue by the onset of childbirth.

Without all this, it is impossible to safely bear a child and avoid dangers to your health and the baby directly during childbirth.

Now medical institutions are strongly advised to remove fibroids by arterial embolization. It is believed that for the patient such a solution will be the most physiological and sparing, in addition, in the statistics of complications during pregnancy, it is mentioned less than all other methods of surgery. Almost all recent studies in this area show that the choice of physicians is fully justified, but be that as it may, the final decision remains with the patient and her physician.

Postoperative period

Rehabilitation after myomectomy is no different from the postoperative period after the traditional opening of the cavity, therefore, it must be treated accordingly.

The first thing to consider is diet. Constipation in such a disease must be avoided in every possible way, and as you know, disturbed stool is a normal phenomenon after surgery.

To enhance intestinal motility, it is very important for a woman in this case to enrich her diet with fiber. In addition, buckwheat porridge must be present in the diet, in turn, it is necessary to refrain from rice, jelly, strong tea for this time. It will also not be superfluous to stock up on chamomile and a string. Microclysters from these herbs are a good help at this time.

Physical activity must be chosen in such a way that the impact on the small pelvis and operated organs is completely excluded. Swimming, leisurely walks, exercise therapy are allowed. For the first 2 months of the postoperative period, it is strictly forbidden to neglect the bandage, it will help to exclude excessive physical impact on the operated area.

The state of the abdominal cavity should be constantly monitored by a woman, the same applies to the scars of the uterine wall, the organs of the small pelvis. Strict observance of all these requirements will directly determine the success of future conception.

Is it possible to become a mother after the removal of fibroids

Volume of myomectomy;
The state of the reproductive organs of the patient after surgery;
Reliability of scars on the operated organ.

It is these 3 factors that determine whether a woman will be able to know pregnancy after removal of uterine fibroids. Almost all doctors agree that scrupulous adherence to the doctor's recommendations, a serious attitude to the issue of diet and the restructuring of one's rhythm of life will significantly increase a woman's chances of conceiving and then carrying a normal child.

An important condition is that at least a year must pass after the operation. Doctors also have a number of additional requirements for already pregnant patients, in particular, they recommend walking in a bandage for the entire period of pregnancy in order to reduce the load on the scar.

Summarizing

Diagnosis of a miotic tumor on the uterus and its subsequent removal today is not a reason for a woman to despair and forget about motherhood. More than half of all operated women are able to give birth after this disease.

The most important thing is to always remember that the well-being of bearing and giving birth to a new person directly depends on the coherence of the actions of the doctor and the expectant mother.

There are several ways to remove uterine fibroids. Each operation has its own characteristics and methods for removing a tumor in the uterus. Is myomectomy possible and after how long?

Myoma is a benign tumor that can be single or plural.

35% of the female population has uterine fibroids.

It can weigh from a few milligrams to tens of kilograms, so women at the initial stage of tumor development are unaware of the presence of the disease.

When does

This benign formation has many reasons for its occurrence, the main ones are:

heredity;

Often, fibroids occur in women due to heredity. If a grandmother, mother had such a problem, most likely, her daughter will also have it.

Sometimes the chain is interrupted at one of the generations.

Hormonal failure happens for various reasons. Stress, sudden weight gain or severe weight loss affects the excessive production of estrogen, which is the causative agent for the appearance of tumor cells. The chance of fibroids in overweight women increases, as it is also produced by fat cells.

The quality of sex plays a very important role. During intimacy, blood rushes to the pelvic organs. Upon reaching orgasm, the blood drains back for several minutes.

If there was no orgasm, blood stagnation occurs in the pelvic organs, which affects the occurrence of fibroids and the deterioration of women's health in general.

How is it treated

There are medical and surgical methods of treatment. Treatment of fibroids with medication is carried out if the woman is of childbearing age, the tumor does not increase and is small. They try to resort to surgical intervention only in rare cases, when it is necessary:

large size of fibroids in the uterus;
fast growing tumor
severe blood loss during menstruation, which leads to anemia;
malnutrition of the fibroid node;
compression of the pelvic organs;
growing fibroids in the cervix (present in 1% of patients with fibroids).

The operation is a serious intervention in the uterus. You must wait at least six months before conceiving a baby.

Pregnancy after removal of fibroids - is it possible

If the tumor was removed locally, after a while a healthy child can be born. But if it was customary to remove the entire uterus, the woman becomes infertile. There are several types of surgery that are used to remove uterine fibroids.

Pregnancy after removal of fibroids by laparoscopy

Two or three small incisions are made. One incision for the laparoscope (a thin tube with a camera and light), the second for the instrument. The operation is technically complex and requires great precision. Laparoscopy is also called a "bloodless" intervention.

This method of operation least damages the uterus, which is very important, if any. Only a doctor will tell you how long to wait with conception. If the formation was small, after six months you can become pregnant. With a more complex operation, you need to wait at least a year.

Invasive removal and pregnancy

There are several ways to remove uterine fibroids.

Open band operation. It happens in the same way as a caesarean section. Most often it is done along the skin fold 2.5 cm above the pubis. With pregnancy after such an operation, you need to wait at least a year, since the incision on the uterus must completely heal.
Robotic myomectomy. The principle is the same as for laparoscopy. The only difference is that the surgeon controls the instruments not with his own hands, but through a special console.
Hysteroscopic myomectomy. Removal of fibroids occurs through the vagina. A special instrument, a resectoscope, is inserted inside. During the operation, he uses an alternating high-frequency current or a laser beam. Such an operation is done in the case of submucosal fibroids (when the tumor grows inside the uterus).

Pregnancy after conservative myomectomy

If you figure out what the term "conservative myomectomy" means, it turns out: "conservo" - to save. This means that this is a type of operation in which the uterus is not removed, but only myomatous nodes are removed. In the future, the role is played by how the fibroid was removed, what size the tumor had, and in what place it was located. The doctor advises the patient, explaining when it will be possible to become pregnant, and for what reasons it should not be done earlier.

Is it possible to get pregnant after uterine fibroids

If the tumor interferes, and drug treatment is not suitable, it has to be removed surgically. After some time, you can conceive a child if the appendages were not removed during the operation.

Straightaway

Under no circumstances should you get pregnant right away. When removing a benign formation, incisions and sutures were made. During pregnancy, a growing baby greatly stretches the uterus, which is why fresh stitches will immediately disperse. This will result in fetal loss, reoperation, and a course of recovery.

After how much can

Depending on the complexity of the operation, the doctor says how long it is impossible to get pregnant. Often, this is from six months to one and a half.

The scar on the uterus must heal. If the connective tissue is from muscle cells, then the uterus is ready for pregnancy. Otherwise, there is a chance of seam divergence. The doctor will check the condition of the suture and let you know when the woman is ready to carry the fetus.

Possible complications

Everyone's recovery period is different. Some quickly bounce back, others suffer pain for a while. There are certain rules that a woman must adhere to so that new myoma nodes do not appear. Recovery after surgery occurs with the help, and at this time alcohol should be excluded. Clothing should be comfortable, not squeeze the seams so that they do not become inflamed.

How is pregnancy after fibroids

If the recommendations for recovery after surgery are followed, the suture on the uterus is healed, and there are no contraindications to pregnancy, then it is possible to conceive a child.

A woman in a post-myomectomy position is constantly monitored by a doctor, but, in fact, carrying a child after surgery is no different from a normal pregnancy.

An operation to remove a tumor in the uterus is the only one. Sometimes the tumor becomes so large that it blocks off the fallopian tubes and the entrance to the uterus, preventing the egg from being fertilized or implanting in the uterus. Before getting pregnant after a myomectomy, it is worth waiting a while. Constantly consulting with a doctor, he will tell you when the uterus is ready to bear a baby.

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Some pathologies of the pelvic organs can adversely affect the reproductive function of the expectant mother, in particular, myomatous tumors. How does pregnancy proceed after removal of fibroids, and why complications may arise?

What types of surgery are used?

When uterine fibroids cannot be eliminated with drug therapy, the tumor can be removed by a doctor through surgery. This is done through the hysteroscopic, laparoscopic method, vascular embolization, and conventional abdominal surgery. Each of these methods has its own characteristics and impact on the reproductive function of women.

Hysteroscopy is one of the safest ways to remove uterine fibroids for a woman who wishes to have a child in the future. The doctor does not make any incisions, penetration into the uterus is carried out through the vagina.

Removal can be performed electrically, laser or mechanically without opening the uterine cavity. The operation takes about 15 minutes, does not leave scars on the uterus, patients recover quickly enough.

Laparoscopy is also safe for expectant mothers, as it allows you to preserve the childbearing function in full. A woman after therapy is rehabilitated in a short time, after about six months she has the opportunity to plan the birth of a child.

Another technique used to remove uterine fibroids is the embolization of blood vessels, which provide the reproductive organ with nutrition. With this treatment, the vessels that feed the neoplasm are blocked, as a result of which the tumor gradually decreases and eventually dies. This method is the most harmless for women planning pregnancy in the future.

In some cases, patients have to agree to abdominal surgery to remove uterine fibroids. This can only be done in particularly severe cases. After such an operative intervention, the reproductive organ acquires scars, the menstrual cycle fails.

The patient needs quite a long time to fully rehabilitate. Pregnancy after this type of myomectomy is possible no earlier than a year later. The probability of conception is very high, but the bearing of a child can be complicated, since there are scars on the uterus.

Is it possible to get pregnant after therapy?

Is it possible to get pregnant after fibroid removal? Thanks to modern medical techniques, it has become possible to preserve the childbearing function in women. The main thing is that in the future after the operation there should be no complications that would prevent the conception and bearing of the baby.

After surgery, the following risks are possible:

The formation of adhesions that can prevent a woman from carrying a child normally.
Re-development of uterine fibroids. No operation can guarantee that after some time the pathology will not reappear. This doesn't happen very often, but it's still possible. This can make it difficult to conceive and carry a baby.
The appearance of scars on the walls of the uterus and bleeding. Scars can form during abdominal surgery. This as a result leads to the development of ectopic pregnancy after removal of fibroids, spontaneous abortion.

The most important and dangerous sign for future pregnancy after fibroids is scarring.

The prognosis regarding the favorable bearing of a child is based on how many such injuries are on the uterus, whether the reproductive organ itself was opened, whether a scar can grow before the baby is born. All these factors determine whether a woman bears a child after surgery or not.

Diseases of the placenta

If a woman has a scar on the wall of the uterus after the operation, then a serious obstacle is created to the normal attachment of the placenta. The fetal egg cannot find the most favorable place for itself, so it has to attach itself in a not very convenient place.

If the fetal egg stops its choice of location on the lower region of the genital organ, then the woman has a complete placenta previa, and the likelihood that bleeding will be disturbed during the bearing of the baby increases. With such a diagnosis, a pregnant woman will not be able to give birth on her own, so a caesarean section is prescribed.

If the placenta is located directly on the uterine scar, then placental insufficiency occurs. As a result, the blood circulation of the reproductive organ is disturbed, thereby worsening the activity of the fetal site. This leads to the fact that the baby does not receive enough nutrients and oxygen.

When the fetus does not fully provide oxygen, disturbances in the intrauterine development of the child's brain occur. And if the baby does not receive the necessary vitamins, then a delay in the physical development of the crumbs is possible. After the baby is born, a variety of malfunctions in the work of the child's body are guaranteed.

The occurrence of a uterine rupture

Another rather dangerous condition for a woman, when pregnancy occurs after removal of uterine fibroids, is a rupture of the organ at the place where the scar passes. This can happen both during gestation and during labor.

The uterus may rupture due to the fact that the scar is very weak and cannot withstand strong stretching. When approaching a rupture during pregnancy after laparoscopy of fibroids, a woman will feel the following symptoms:

Nausea and vomiting.
Pain in the abdomen, radiating to other areas of the body.
Overstrain of the muscles of the reproductive organ.
Blood discharge from the vagina.

If the rupture of the uterus has already occurred, then there are also such signs as:

The rapid deterioration of the general condition of a woman.
Vertigo.
Reduced blood pressure.
Increased heartbeat.
Broken breath.
Paleness of the skin.

When the uterus ruptures, a lot of blood enters the abdominal cavity, fetal hypoxia occurs, and the baby's condition worsens. In this case, urgent medical attention is important.

If the uterus began to rupture directly during labor, then the following manifestations are noticeable:

Nausea, vomiting.
Pain syndrome.
Weakness.
Increased pain during contractions.
Poor progress of the baby, despite the full disclosure of the uterine cervix.

Also, an overstrain of the muscles of the uterus is added, the appearance of blood discharge from the vagina. The rupture of the reproductive organ occurs almost immediately after the onset of these symptoms. Therefore, it is necessary to provide urgent medical care, otherwise the pregnant woman and the baby may die.

How is a second pregnancy planned and managed?

After how much time you can get pregnant, the attending physician decides. Before conception, you should definitely check your body well so that in the future there will be no problems with gestation and childbirth.

If a woman becomes pregnant, then it is necessary to register as early as possible, no later than 12 weeks. In the process of gestation, it is necessary to undergo an examination. Ultrasound is one of the most important.

It allows you to identify signs of failure of the scar on the wall of the uterus, namely, to determine whether its contours are intermittent, whether the muscles of the genital organ are thinned, whether there are particles of connective tissue in the scar.

If an inconsistent uterine scar is detected, then the woman will not be allowed to give birth on her own. In this case, only a caesarean section is indicated. Otherwise, natural childbirth after myomectomy can cause a rupture of this damage, the formation of bleeding, the death of the woman giving birth and the child himself.

If a full-fledged scar is found, the doctor may allow you to give birth on your own, but only under the following conditions:

Head presentation of the fetus.
The same size of the head of the baby and the pelvic part of the pregnant woman.
Finding the placenta outside the scar.
The absence of negative consequences of bearing a child.

In the case when the myomectomy of the uterus is carried out directly during the bearing of the baby, then the woman will give birth exclusively by caesarean section. If in the process of natural childbirth with a full-fledged scar, complications suddenly arise or the condition of the baby worsens, then emergency assistance is provided through a caesarean section.

rehabilitation period

In order for a woman to be able to fully recover and think about future offspring, she needs to follow certain rules after laparoscopy of uterine fibroids or other operations. The patient must take the medicines prescribed by the doctor.

At home, it is important to monitor your health, you should not allow overwork, hypothermia, lifting heavy loads, prolonged stay in the sauna, bath or on the beach. You need to spend more time outdoors, eat right.

Thus, it is possible to conceive and give birth to a child after a removed fibroid, even of a large size. But it depends on many factors, so each case is individual. When you can conceive a child, only the attending physician can say more precisely.

Content:

Quite often, women of reproductive age have questions about the possibility of pregnancy with uterine myoma or after an operation to remove it. It is very important to make the right decision about the management tactics of each individual patient. Are uterine fibroids and pregnancy compatible?

Myoma is a benign tumor made up of muscle tissue.

Occurs when the muscle cells of the uterus actively begin to divide. Doctors have not fully figured out why this happens, but the most likely cause is hormonal stimulation and increased secretion of estrogens.

Is it possible to get pregnant with uterine fibroids?

The answer to this question depends on many factors to consider:

Localization of the myomatous node

If there is a localization of the myomatous node in the cavity or wall of the uterus in such a way that the cavity is deformed, or on the cervix, then pregnancy is physiologically impossible. Knots of this arrangement act as a spiral, they are a kind of contraceptives. Spermatozoa simply remain on the surface of these nodes and do not reach the fallopian tubes. Therefore, the egg and sperm do not meet. Such nodes should be removed!

With small sizes of myomatous nodes and location in the wall of the uterus itself or outside (subserous localization), in the absence of deformation of the cavity, pregnancy can occur under other satisfactory conditions. In the case of the nodes described, it is possible to plan a pregnancy. In the future, problems are still possible, they can be associated with gestation, but according to statistics, their frequency is about 15-20%.

If there is a node with a thin stem, during pregnancy there is a risk of torsion, this will lead to emergency surgery and possible interruption. If you are preparing to become a mother, such nodes should be removed first.

growth trend of fibroids

If, according to the results of ultrasound and observations, the fibroid is growing rapidly, i.e. increases in size by 1.5-2 times in a period of six months, then planning a pregnancy with uterine myoma is impossible. In this case, there is a high risk of growth of fibroids during gestation, there is a possibility of a violation in the nutrition of the myomatous node, and the risk of miscarriage increases. In this case, it is necessary to pre-treat.

Fibroids size

If the fibroid is large (the size of the uterus exceeds 10-12 weeks of pregnancy, and in the case of IVF if the fibroid is more than 4 cm), it is not worth planning a pregnancy, there is a high probability of miscarriage and malnutrition during the gestation period, which can lead to emergency surgical intervention . Yes, and the onset of pregnancy in this case is unlikely, because. in 60-70% of such patients, endometrial pathology occurs, which makes it impossible to implant the embryo.

Do uterine fibroids grow during pregnancy? It is not possible to predict the "behavior" of fibroids during this period. This is a genetically determined factor. According to statistics, 65-75% of the nodes decrease by about 30%, but 25-35% of fibroids during pregnancy can grow, and very rapidly, and, as a rule, the increase occurs by 100%.

How to remove fibroids during pregnancy planning?

The question of the method of surgical intervention in the case of uterine fibroids is rather complicated. Laparoscopy, on the one hand, has more advantages, the main of which is a decrease in the likelihood of an adhesive process developing in the small pelvis. Subsequently, this will maintain patency in the fallopian tubes, which is an important factor in the fertilization of the egg. With laparotomy, the likelihood of adhesion formation is noticeably higher, and their appearance becomes possible both in the small pelvis and in the abdominal cavity. In the future, this will lead, in addition to infertility, to complications in the gastrointestinal tract.

However, on the other hand, it is believed that in the case of large fibroids, when performing laparoscopy, it is not always possible to suture the uterus in the right way. This is associated with laparoscopic technique.

The quality of healing of the suture on the uterus may vary in different patients and depends on several factors:

Body Features
The quality of the scar when suturing the uterus (formation of the scar, correct matching, layering of suturing)

So, the most optimal (maximum) size of nodes for a possible laparoscopy for a patient planning to become pregnant is 5-6 cm. For suturing in this case, special skill of the surgeon is required. In the case of large nodes, new technologies have already been developed for suturing the uterus, which make it possible to strengthen its walls, but the risk of uterine rupture along the scar is always higher in this case.

In the presence of nodes larger than 9-10 cm, the risk of rupture along the scar is higher than the risk of adhesion formation after laparotomy. Here, surgeons, as a rule, refuse laparoscopy and perform abdominal surgery, taking into account the reproductive wishes of the woman.

The incidence of adhesion formation after laparoscopy is significantly lower than during laparotomy. But with large myomatous nodes, endometriosis and inflammation of the appendages, genetic features in the postoperative period, there is a risk of re-development of the adhesive process. According to statistics, the likelihood of adhesion formation is higher when the myomatous node is localized in the uterus on the back wall. The reasons for this fact are not clear at the moment.

If there are concomitant pathologies (chlamydia, endometriosis, gonorrhea, etc.) in patients who are interested in pregnancy, after about 6-8 months, a control laparoscopy is performed to assess the condition of the fallopian tubes. The issue of reoperation is always decided individually, taking into account many factors and individual characteristics.

After a laparotomy in case of removal of a large fibroid, due to the fact that there is a high probability of formation of adhesions, control laparoscopy is performed in most cases in order to restore the patency of the fallopian tubes.

When can I get pregnant after surgery?

After surgery to remove fibroids, regardless of the method (laparotomy or laparoscopy), you can become pregnant after 8-12 months, it depends in most cases on the size of the removed node. With small sizes (3-4 cm), pregnancy can be planned in eight months. Such restrictions are associated with the physiological characteristics of the restoration of the muscles of the uterus. The resorption of sutures, on average, is completely completed only after 90 days from the day of the operation. Given that the size of the uterus during pregnancy increases significantly, the muscles stretch and hypertrophy very much, it is necessary that the healing of the scar is complete.

Indications for caesarean section after such an operation are determined individually each time and depend on the size of the fibroids that were removed, because. this affects the size of the scar, from its previous location, from concomitant indications (the age of the pregnant woman, the duration of infertility treatment, the presence of preeclampsia), from ultrasound data of the suture during pregnancy.

In general, with the removal of fibroids up to 3-4 cm, the absence of complications, a young age, and a satisfactory condition of the scar according to ultrasound, natural childbirth is possible.

Uterine rupture and multiple fibroids

After an operation to remove fibroids, after a previous caesarean section, in any case, if there is a scar on the uterus, there is a possibility of its rupture during pregnancy. According to some reports, the frequency of breaks is about 6%, but this is not an exact figure.

It is quite difficult to determine the probability of a gap, because it is determined by the individual characteristics of the tissues of the muscles of the uterus, it is almost impossible to evaluate them. Patients with a scar on the uterus need a more careful attitude during pregnancy, it is necessary to constantly assess the blood flow in the scar, its condition, a timely developed plan for childbirth, early hospitalization before childbirth, etc. is necessary.

In most cases, fibroids are represented by several nodes. The situation with planning pregnancy with multiple myoma is quite complicated. In some cases, several nodes of different sizes are localized in the uterus, and if they are all removed, there may be practically no healthy tissue left.

In these cases, only those myoma nodes that interfere with pregnancy are removed, i.e. localized so that they interfere with the attachment of the embryo, or those nodes that have a tendency to grow rapidly. After childbirth, it is already possible to remove the remaining nodes or carry out removal during caesarean section. It is not advisable to remove all myomatous nodes when planning and preparing for pregnancy in case of a large number of them, because. this can adversely affect the very possibility of becoming pregnant, bearing and the course of childbirth.