It is never easy to decide to have surgery. For women whose fibroids are interfering with their dream of having a child, it can often be the best option. Women considering an expensive and invasive in vitro fertilization procedure have gotten pregnant with no medications after having fibroids removed.
As you can see in the picture above, the fibroid is interfering with the uterine cavity. The embryo can only attach to normal uterine wall lining and a good percent of this woman's lining is taken up with a fibroid. Even if the embryo can implant on this tissue, it will not be able to get enough of a blood supply out of the fibroid to grow.
Fibroids can grow up inside the uterine lining. These fibroids are best diagnosed with the test above, a sonohysterogram which is an ultrasound with fluid inserted into the utrus through a tiny catheter. I am fortunate to have a wonderful sonographer and excellent ultrasound equipment, so I am able to offer this test in my office to my patients.Some physicians send their patients to a hospital facility, which is much more expensive. (Not to mention that radiologists are often not as experienced with the speculum as those of us who insert them gently all day every day.) The main discomfort of a sonohysterogram is cramping so it is a good idea to take whatever you take for menstrual cramps before the appointment.
Once finding fibroids and ascertaining that they are more likely or not the culprit, the next step is deciding on the best type of surgery.
This picture is from a different patient and shows what fibroids look like when you are looking directly at them with a camera. These fibroids are contained within the uterine lining and I took them out with an amazing instrument called a myosure that goes through the speculum "from below" without any incisions.
I make sure to numb the uterus while my patients are asleep and many report only mild cramping and some have told me that they have no pain. Of course, everyone is different and I make sure that everyone is prepared for significant discomfort.
The fibroid in the sonohysterogram may or may not be entirely accessible from below. I would make sure that woman understood that we might need to also look from above, robotically to get to the fibroid. Before surgery, she would tell me that she could afford the extra time off from work for a more involved surgery at that time. That fibroid has good borders, so there is a great chance that could get to everything come below, but I always like patients to know what I am anticipating.