Myomas and In Vitro Fertilization


What is Myoma?

Myomas are benign tumors originating from the muscle tissue of the uterus and formed by the effect of estrogen. They can be seen in 20-25% of women who are routinely checked, and 90% do not cause any complaints. Only 10% of myomas will cause a complaint to the clinic. Cancer conversion probabilities are around 0.1-0.5%. Must come to mind in fast growing and degenerating myomas


In which parts of the uterus do myomas settle and what complaints do they cause?

Myomas can be located in the inner part of the uterus called the endometrium tissue and are called “submucous myoma”. The most common complaint is observed in myomas located in this region and often cause excessive and / or prolonged menstrual bleeding, intermediate bleeding or menstrual pain.

Myomas that are inside the muscle wall of the uterus are “intramural myoma”. If they extend to the inner tissue of the uterus and press on the endometrium, they can cause excessive menstrual bleeding, prolonged menstrual bleeding, intermediate bleeding, or menstrual pain. If they have grown too large, they may cause frequent urination or constipation by pressing organs such as the bladder and rectum in the back.

Myomas growing under the outer membrane of the uterus, that is, outside the uterus, are called “subseous myomas” and generally do not cause bleeding complaints. If they grow too big, they can press urinary bladder and urinate frequently, or cause pressure on the rectum.

Myomas that can settle anywhere on the wall of the uterus can also be located inside the ligaments on the right or left of the uterus and become ‘intraligamentary myoma’. It will not cause complaints unless it grows too big. When it is placed in the cervix, it gets the name “cervical myoma” and at this point, it is highly likely to make signs of bleeding and pressure.

If there is a large number of women in myoma, the location, number and size of bleeding, pain, or signs of pressure in the surrounding organs can be observed more frequently.


Does myoma have an effect on infertility and when is surgical treatment performed?

In most myomas, its relationship with infertility may not be determined exactly. The clearest relationship is in submucous myoma located just below the endometrium (uterine membrane). The myoma, which compresses the endometrium, will disrupt the blood supply in this region and prevent the embryo from settling comfortably or increase the risk of miscarriage.

In the location, which can prevent the passage of the tubes on both sides, myomas can prevent the sperm from reaching the egg or migration of the embryo from the tubes into the intrauterine tissue.

Myomas that settle in the cervix can prevent the sperm from going into the intrauterine tissue and thus the tubes.

The relationship between intramural myomas located in the muscular wall of the uterus and infertility is not always clear. We think that intramural myomas that do not press the intrauterine tissue and are under 5 cm do not have much effect on fertility. But if there is recurrent miscarriage, recurrent IVF failure or myoma 5 cm. Surgical removal should be considered.

Subseous myomas located under the outer membrane of the uterus have no effect on fertility and surgical treatment is not required for fertility. However, there may be problems with the woman’s compression findings (frequent urination, constipation) and gynecological indications can be performed.

Unfortunately, myomas have no medical treatment. Radiologically performed myoma embolizations can be performed on patients with anesthesia or surgery risk, but it is not suitable for women who are trying to maintain fertility due to blood supply problems. If necessary, the only effective treatment method for myomas is surgery.

In fast growing and degenerating myomas, surgery should be planned with open surgery, laparotomy, if possible, due to the possibility of “malignant: sarcoma”.


In which way are myoma surgeries performed?

If submucous myoma located just under the lining of the uterus and at least 2/3 of this is in this localization, myoma can be taken by hysteroscopy. If myoma is too large, surgery may be required in 2 sessions due to the unique risk of “water poisoning” of hysteroscopy.

For myomas in the uterus or under the outer lining of the uterus, myomas can be taken by laparoscopic or open surgery by looking at the patient’s age, number of myomas, size of the myomas, and locations of the myomas.

If the patient’s myoma has been detected before pregnancy and it is dangerous location, size or number, it is useful to perform surgical treatment before conception.


How many months after myoma surgery can not get pregnant?

It is not appropriate to conceive for 6 months after myoma surgeries. Especially if the intrauterine tissue has been reached and this tissue has been repaired, 6 months must be waited before conception. If the woman’s ovarian reserve is decreased, ovulation induction can be performed and the embryo can be frozen in order not to lose time and reduce the chance of pregnancy.


What are the effects of myomas and myoma surgeries on pregnancy and births?

How myomas affect pregnancy and birth is related to the number, location and size of myomas.

Submucous myomas, which are located in the intrauterine tissue and where the embryo is located, are the most problematic group. It may prevent embryo from settling or increase the risk of miscarriage and premature birth.

Intramural myomas located in the uterine muscle tissue may increase the risk of miscarriage and more often preterm labor by disrupting the blood supply of the uterus depending on the location and size, or by causing unnecessary contractions in the uterus.

Subseous myomas under the outer membrane generally do not increase the risk of miscarriage or premature birth and often do not affect labor.

Myomas often have no effect on the mode of delivery and do not pose a risk for normal (vaginal) delivery. However, they can prevent regular and effective uterine contractions required at birth according to their location, number and size, and can lead to a condition called difficult progress or difficult action in labor. In myomas that partially or fully cover the cervix, it will not be possible for the baby to pass from the cervix to the vagina. For these reasons, caesarean may be required.

If the woman has undergone myoma surgery and especially if more than one myom has been removed, it is better to avoid normal delivery and perform cesarean if the uterus called endometrium has been reached during the operation and has been repaired.