Infertility relates to the incapability of achieving pregnancy due to certain medical issues in males or females.
With a record 27.5 million couples wanting to conceive but suffering from infertility, there is an alarming increase of infertility complications in India due to a multitude of reasons.
However, before approaching them, it is essential to emphasize that infertility is not solely a female problem which appears to be a popular orthodox belief but can involve both male and female, since it takes both to conceive.
According to The World Population Prospects, a research study suggests that nearly 1.5 percent more men have infertility than women.
The factors responsible for infertility can be divided into clinical and lifestyle patterns that do not complement a healthy reproductive system.
All around the world, women and men are increasingly dealing with fertility issues due to various changes in the everyday environment and lifestyle.
The sedentary lifestyle they follow, and the addictions are the primary culprits here.
Other external factors such as pollution and stress also affect semen production and quality. In addition, women with lifestyle issues like obesity and diabetes tend to have increased chances of infertility.
Over 40 percent of women attending infertility clinics are found to be obese. Infections, genital Tuberculosis, polycystic ovarian syndrome (PCOS) and fibroids are other areas of concern among women.
Widespread use of emergency contraception and surgical abortions can trigger serious infections that may cause irreversible infertility.
Let us look at how fibroids affect fertility among women.
What Are Fibroids?
Although women can have single or multiple fibroids, in extreme cases, multiple fibroids can add weight to the abdomen region and cause a lot of discomfort.
Fibroids are usually non-cancerous tumors that are found in the uterus. These are made of muscle cells and fibrous tissues.
The lumps can range in size, from small seedlings that are invisible to the naked eye to enormous growth, leading to enlargement of the uterus. It is very rare for women to contract cancerous fibroids.
Although women can have single or multiple fibroids, in extreme cases, multiple fibroids can add weight to the abdomen region and cause a lot of discomfort. Many a times they have no symptoms, then it is particularly tough to detect them until certain tests are taken.
Kinds of Fibroids and How They Affect Fertility
Depending on the location of fibroids that exist, they are classified into 4 different categories:
Subserosal Fibroid
Subserosal fibroids grow on the outer side of your uterus on the serous membrane (or serosa), which is the outer lining that all organs and internal body cavities have.
Subserosal fibroids may grow big enough that they can make your womb look bigger on one side.
Intramural fibroids
Intramural fibroids appear in the muscular wall (myometrium) of the uterus and are the most common type of fibroid.
Due to the location of intramural fibroids, they may grow larger and can stretch the womb.
Submucosal fibroids
Submucosal fibroids grow in the myometrium beneath the inner lining (endometrium) of the uterus.
They can bulge into and distort the uterine cavity.
This type of fibroids is less common compared to the other types, but they cause the most symptoms like irregular or heavy bleeding.
Pedunculated fibroids
Pedunculated fibroids form when a fibroid (subserosal or submucosal) develops a stem. This stem has slender base that supports the tumor to grow.
Untreated Uterine Fibroids: Cause for Concern?
Mostly fibroids remain harmless, but depending on the size and location, they can cause concern.
Various symptoms like heavy and prolonged bleeding during menstrual cycles that can lead to anemia, chronic pain in the pelvic region, infertility/miscarriage issues, pain in the back and legs, the constant urge for urination etc.
These symptoms can lead to immense pain and discomfort if left untreated, which is why it is recommended to visit your doctor and get the issue checked.
Diagnosing and Treating Infertility
Your Gynaecologist may recommend you take various tests to diagnose the exact issue that prevails.
Women may have to undergo a general physical and regular gynaecological exam; some standard tests to confirm the diagnosis of fibroid include-
1) Ultrasound
It is the most used technique for detection of fibroids. It uses sound waves of much higher frequencies (than what we can hear) to generate an image.
Here the ultrasound probe, either trans abdominal (over abdomen) or trans vaginal (inside the vagina), is used to do the scan and create an image of the uterus and ovaries which is displayed on the monitor and hence can pick up anything abnormal.
Ultrasound is quick, simple and generally accurate.
3) MRI
This test uses magnet and radio waves to produce images.
MRI gives us precise information about the size, number, and location of the fibroids.
We can also distinguish between fibroids and adenomyosis which sometimes get misdiagnosed.
3) Hysterosalpingogram (HSG)
For this test the doctor places a catheter in the uterus and then a dye is injected slowly for contrast and then X-ray images are taken.
By this we can check the inside of uterine cavity and the patency of fallopian tubes and detect any abnormality of these.
How Can It Be Treated?
Not all fibroids need treatment, after the relevant investigations your gynecologist will suggest in which cases surgery is required. In some cases, surgery will be required like in cases of large fibroids, those distorting cavity, severe symptoms etc., to restore fertility through Hysteroscopy and Laparoscopy.
After the correction of the problem couple can be advised for trying to conceive either naturally or by the help of the other available techniques (IUI / IVF) depending on the other existing comorbidities like ovulation issues, problem in male partner, advanced age etc.
Intrauterine insemination (IUI) is a process where healthy sperm are placed in the uterus when the ovaries release eggs for fertilization.
Assisted reproductive technology (ART) like In vitro fertilization (IVF) is also a form of treatment involving fertilization of eggs in lab and the embryos formed are directly transferred in the uterus.
All the above treatments are safe and have helped many couples conceive over time.
However, following the doctor’s advice is recommended while going through any of the above-mentioned treatment to avoid complications.
(Dr Radhika Bajpai is a Consultant at the Birla Fertility & IVF, Gurgaon.)
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