In our previous discussion, we identified the types of fibroids. However, the most common question patients at Talwar Fertility & Child Health Centre ask is: “Do I need to remove my fibroid before I can get pregnant?” The answer lies in precision mapping and understanding the FIGO classification of leiomyomas.

The Decision-Making Matrix

Using high-resolution Transvaginal Ultrasound, we evaluate whether a fibroid is a “silent bystander” or a “fertility blocker.” The clinical decision to treat depends on:

• The FIGO Grade: We grade fibroids from 0 to 7. Grades 0, 1, and 2 (Submucosal) almost always require removal as they occupy the space meant for the embryo.
• The 4cm Rule: Intramural fibroids (Grade 3 or 4) larger than 4-5 cm may reduce IVF success rates by altering blood flow to the endometrium.
• Vascular Mapping: Using Color Doppler, we check the ‘vascular rim’ of the fibroid. Highly vascular fibroids might grow rapidly during the high-estrogen phase of IVF stimulation.

Advanced Imaging: Beyond Basic Scans

For complex cases involving multiple fibroids, we often employ:

Treatment Options in Gurugram

If management is required, our approach is always minimally invasive to preserve uterine integrity:

• Hysteroscopic Myomectomy: For submucosal fibroids; no external incisions are made.
• Laparoscopic Myomectomy: For larger intramural or subserosal fibroids, ensuring a quick recovery.
• Medical Management: In some cases, we use hormonal down-regulation to shrink fibroids before starting an IVF cycle.

Uterine fibroids (leiomyomas) are non-cancerous growths of the uterus that often appear during childbearing years. While many women have fibroids without any symptoms, for others, they can cause heavy bleeding, pelvic pain, and significant fertility hurdles. Ultrasound is the primary tool used to map these growths and plan effective treatment.

Types of Fibroids Based on Location

The impact of a fibroid depends heavily on where it is located within the uterine wall. During an ultrasound, we categorize them into three main types:

• Intramural Fibroids: These grow within the muscular wall of the uterus. If they become large, they can distort the shape of the uterus.
• Subserosal Fibroids: These project outside the uterus. While they may cause pressure on the bladder or bowels, they often have the least impact on fertility.
• Submucosal Fibroids: These bulge into the uterine cavity. Even small submucosal fibroids can interfere with embryo implantation and are a common cause of infertility and miscarriage.

Sonographic Appearance

On a Transvaginal Ultrasound (TVS), fibroids typically appear as well-defined, solid, hypoechoic (darker) masses. We use Color Doppler to assess the blood supply to the fibroid, which is essential when planning surgical interventions like a myomectomy.

Fibroids and Fertility Success

At Talwar Fertility & Child Health Centre, we emphasize that not all fibroids require surgery. However, if a fibroid is blocking the fallopian tubes or preventing an embryo from attaching to the uterine lining, specialized removal may be necessary before proceeding with IVF. Our advanced imaging allows us to make this decision with clinical precision.