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UTERINE FIBROIDS AND THEIR RELATIONSHIPS WITH INFERTILITY

By definition, fibroids are benign tumors that develop from the smooth muscle structure. There is a possibility of development in all areas of the body that actually have smooth muscle structure. Since the uterus is an organ composed of smooth muscles, fibroids can also develop in the uterus. Fibroids are common tumors in women. It is usually seen in middle and late reproductive (reproductive) women. Although they are usually more than one number, they may appear as single fibroids.

Fibroids usually present in the patient according to the size and region of the uterus. Fibroids formed on the outer part of the uterus or within the muscle layer may not show any symptoms when they are not very large. However, when it is very large, it may present with symptoms such as inguinal pain, urine problems, constipation and bloating. In addition, fibroids in the muscle layer can cause menstrual irregularities in the woman because of the characteristics of the tumor and the pressure on the cervix (such as prolonged menstruation and abundant bleeding). Uterine fibroids (the location where the baby develops; the menstrual site every month) usually show signs in the patient. These types of fibroids can also cause inguinal pain, menstrual pain, increase in the amount and prolongation of bleeding, and intermediate menstrual bleeding.

Although fibroids are benign tumors, there is also a type of malignant called leiomyosarcoma. Very few of these fibroids are surgically removed. (1 in 1000-2000). There is still no more scientific evidence that benign fibroids have become malignant. If the fibroids detected by ultrasound is too large or grows rapidly during follow-up, this may cause suspicion in terms of cancer and such fibroids may need to be removed and examined in pathology.

The relationship between fibroids and infertility is still controversial. The discussion is usually related to the location and size of fibroids and whether they are associated with infertility. It is known that fibroids in the cervix can cause miscarriages and decrease the chance of pregnancy in IVF treatments. For this reason, fibroids detected in the cervix must be removed by hysteroscopy. Outer uterine fibroids that do not compress the uterus do not have a negative effect on in vitro fertilization and pregnancy, but it is useful to remove them when they are 8 cm or more in size. In the case of fibroids formed in the muscle layer of the uterus, if there is no pressure on the lining of the uterus and their size is below 5-7 cm, they may not be removed by surgery. However, there are also reports that these fibroids may reduce the chance of pregnancy in IVF treatments even if they are less than 5-7 cm in size, even if they do not pressure the uterus.

Drug treatment of fibroids is a subject that has been investigated for many years. Although there are mainly drugs that can reduce the size of fibroids, when fibroids are discontinued, fibroids return to their original size. The main purpose of drug use is to reduce the size of fibroids in the uterus, especially before surgery. They can also be used to help temporarily reduce the complaints of patients who cannot undergo surgery. It has not been proven that widely used birth control pills and progesterone drugs reduce the size of fibroids.

As a result, fibroids are common structures in patients receiving infertility treatment. Infertility treatments should be initiated after deciding whether to perform surgery according to size instead of fibroids. If uterine muscle fibroids are removed, it should be kept in mind that pregnancy should not be at least 3-6 months after surgery. Fibroids in the uterine membranes must be removed by hysteroscopy before a sterility treatment. If fibroids up to 4-5 cm in size do not put pressure on the uterine muscle layer and uterine membrane, it may not be necessary to remove it first.