Uterine fibroids

Abstract

Uterine fibroids are often identified by ultrasonography during an infertility evaluation, with a peak incidence of 70-80 % of women during the late reproductive years. Precise identification of the size, number, and location of fibroids is determined by ultrasound. In most circumstances, detailed fibroid mapping can be accomplished with transvaginal ultrasonography. Abdominal ultrasound is needed when the uterus is large, when fibroid calcification limits uterine assessment, or when the ovaries cannot be identified with transvaginal ultrasound. Saline infusion sonohysterography is extremely useful to identify submucous fibroids and to define the relationship of intramural fibroids and the endometrial cavity. Three-dimensional sonography provides diagnostic insight when complex uterine abnormalities are identified. Tubal patency can be assessed by infusing saline and air bubbles during sonography and the examiner can determine if an adjacent fibroid is the cause of proximal tubal occlusion. Most uterine fibroids are asymptomatic, but some cause significant morbidity. Submucosal fibroids reduce fertility and compromise pregnancy, and outcomes are improved after hysteroscopic myomectomy. In select cases of hysteroscopic myomectomy, concurrent abdominal ultrasound helps to provide guidance and enhances the safety and efficacy of the procedure. Women with untreated fibroids have a higher incidence of maternal and fetal pregnancy-related complications, and there is increasing evidence that fertility and pregnancy outcomes are improved following myomectomy. Laparoscopic or abdominal myomectomy is appropriate for women with symptomatic intramural, subserosal, or pedunculated fibroids who desire fertility. Intracorporeal ultrasound may be useful when a fibroid deviates the endometrial cavity but cannot be identified by visual inspection of the uterus during myomectomy. Approximately 50 % of women conceive after myomectomy, and IVF outcomes may improve.