Fibroids and Fertility (2)

Fibroids and Fertility (2)

How do you decide how to have your fibroids removed if they are interfering with your ability to get pregnant or if you just want to keep the option of pregnancy open?

If you are lucky enough to have all of your fibroids in your uterine lining and they are of a size that can be done without incisions with the hysteroscope, that is definitely the way to go.

However, many fibroids are either too big to be removed through the hysteroscope or they can not be reached from below and an abdominal approach is necessary.  The options are open or robotic.  Within the fertility community, there is a disagreement.  I have referrals from fertility specialists who want me to do a myomectomy on the robot for their patients and others who want me to do an open myomectomy (an open incision.)  Especially if the fibroid is very close to or even going into the uterine cavity, I recommend an open myomectomy because you can use much smaller and more delicate suture to repair the lining of the uterus which causes less scar tissue.

I also tell patients having an abdominal myomectomy, whether open or robotic, that they should plan to have a C-Section for delivery.  Occasionally, a fibroid will be superficial, but even if the ultrasound or even an MRI does not show a fibroid going deep into the uterine muscle, at the time of surgery it often does.  I like to let patients be as prepared as possible for expected outcomes.

After a robotic or open myomectomy, you should not drive for two weeks.  You are just too sore to have quick enough reflexes.  Time off from work usually ranges from 2-6 weeks.  I recommend taking 6 weeks off from work and if you are a quick healer, you can go back earlier.  Women who can work from home can often resume that type of work around 2-3 weeks.  Women with more physical jobs such as teachers, doctors, nurses, hair dressers, waitresses, bar tenders etc. should take the full 6 weeks.  It is important you give yourself enough time for a proper recovery.