Diagnosis and Treatment by the Expert Fertility Surgeons at Texas Fertility Center
Endometrial polyps and uterine fibroids are 2
types of benign growths that can develop either
inside the cavity or inside the wall of the uterus.
Depending on their size and location, they can
significantly affect fertility as well as cause
heavy, irregular, and or painful bleeding.
Polyps are small, grape-like growths of the lining
of the uterus. They may be diagnosed during an
ultrasound or a hysterosalpingogram (HSG a.k.a.
x-ray dye test of the uterus and fallopian tubes).
Uterine polyps can be removed during a procedure
called a hysteroscopy, which involves placing a thin
operative telescope into the uterus.
Fibroids differ from polyps in that they are solid
tumors made of smooth muscle and are much firmer
than the softer polyps. They are rarely cancerous
(<0.1%) but still frequently need to be removed due
to the symptoms that they can cause. The most common
symptoms of fibroids are heavy and/or painful
bleeding, but this depends on their size and
location. Fibroids can also cause constipation, a
frequent urge to urinate, and pain with intercourse.
Like polyps, fibroids are commonly diagnosed during
an ultrasound or HSG.
Fibroids can decrease fertility in a variety of
ways. They may distort the uterine contour,
interfering with embryo implantation. They may also
obstruct the fallopian tube openings into the
uterus. Certain fibroids may increase the risk of
miscarriage or pregnancy complications.
The treatment strategy for patients with fibroids
varies depends upon their size and location as well
as multiple other patient-specific factors:
Submucous fibroids grow within the inner cavity of the
uterine. They can be treated during an outpatient procedure
called a hysteroscopy. This involves placing a slim telescope
through the vagina and cervix into the uterus.
Intramural fibroids grow within the wall of the uterus. If they
are larger than3-4 cm, they may be removed either by a
laparoscopy or laparotomy. A laparoscopy is an outpatient
procedure during which a slim telescope is passed through the
belly button into the abdomen. Additional surgical instruments
are passed through 1-2 other small incisions (< 1cm) made just
above the pubic bone. Using these instruments, your physician
can remove the fibroids and repair the uterus so that it will
retain its normal function.
A laparotomy refers to an inpatient surgical procedure during
which a single larger incision is made in the lower abdomen.
This type of surgery may require an overnight stay in the
hospital. The decision to approach your fibroids either
laparoscopically or via a laparotomy will be made by your
physician based on the size, number, and/or location of your
fibroid(s).
Subserosal fibroids grow outward from the uterine wall. They are
not thought to play a major role in infertility, but they may be
removed if they are causing you other symptoms, such as pain or
pressure on surrounding organs like your bladder or intestine.
Both fibroids and polyps are typically discovered during the
basic infertility evaluation. If you have them, your physician will
discuss them with you in detail. He or she will also make a
recommendation as to whether or not they need to be treated, as well
as the optimal surgical approach to remove them should that be
necessary.
