Uterine Fibroids and Recurrent Pregnancy Loss
Uterine fibroids are associated with miscarriages and may be a cause of recurrent pregnancy loss. A recent study from the United Kingdom (Human Reproduction 26:3274;2011) found that the intrauterine cavity was distorted by fibroids in 8.2% of women with a history of recurrent pregnancy loss. They also found that surgical removal of these intrauterine fibroids increased the chance of their next pregnancy delivering a healthy baby by as much as 50%. This study exemplifies the importance of a thorough evaluation including intrauterine cavity assessment for women with a history of recurrent pregnancy loss so that intervention can occur to prevent another miscarriage.
The most cost effective method of determining the size and location of uterine fibroids is a Sono-hysterogram or SONOHSG. This procedure is best performed shortly after cessation of menses and before ovulation. The choice of surgical procedure is dependent on location of the uterine fibroids. For those within the cavity, called submucous fibroids, the treatment of choice would be an operative hysteroscopy. For uterine fibroids of sufficient size within the musculature of the uterus but not interfering with the intrauterine cavity, called intramural fibroids, an abdominal approach either by operative laparoscopy or laparotomy is required. For subserous fibroids (outside the body of the uterus) or pedunculated fibroids, surgery is not necessary unless they are associated with discomfort.