Myomas, which develop from the uterine muscles and are popularly known as tumors, are benign tumors. Myomas affect 20-50% of women of childbearing age, and their incidence increases with age. Myomas can be single or multiple and of different sizes. They can remain very small for a long time, suddenly grow rapidly, or grow slowly over years.
Myomas, which are found in approximately 5 - 10% of women with infertility, can be the sole cause of infertility in 1 - 2.4% of women. The relationship between myomas and infertility and recurrent pregnancy losses, and the chances of women with myomas getting pregnant have been investigated in many studies. Before infertility treatment, the issue of what size and location myomas should be removed and when, and whether infertility treatment or myoma surgery should be performed first is controversial.
How is the diagnosis made in myomas?
The locations of myomas, their sizes, Their relationship with the uterine cavity is determined by gynecological examination and ultrasound performed during this time. Additionally, tests that support the diagnosis:
Saline Infusion Sonography (SIS): Physiological saline is injected into the uterus and the uterus is examined under ultrasonography. In this way, differential diagnosis of myomas or polyps in the uterus can be made.
Hysteroscopy: The inside of the uterus is viewed with a hysteroscope, a thin instrument with a camera at the end.
Hysterosalpingography (HSG): It is a special x-ray film. It detects abnormal changes in the shape and size of the uterus and tubes.
Laparoscopy: The inside of the abdomen, uterus, ovaries and tubes are viewed with a laparoscope, a thin instrument inserted through a small incision made in the navel.
Myomas. They settle in 3 different regions of the uterus
1. Submucous Myomas
They are myomas that grow from the inner surface of the uterus into the uterine cavity. Although it is the least common type of myoma, it can prevent pregnancy and cause miscarriage. Although sometimes it does not cause any complaints, bleeding problems are common in this type of myoma. Bleeding usually occurs in the form of an increase in menstrual bleeding and a prolonged period.
2. Intramural Myomas
They are myomas located within the muscle tissue of the uterine wall.&nbs. p; It is the most common type of myoma. Like submucous myomas that grow towards the inner surface of the uterus, they cause increased menstrual bleeding, prolongation of the menstrual period and related anemia. At the same time, they can cause problems such as abdominal pain, a feeling of fullness as a result of the growth of the uterus, and frequent urination as a result of pressure on the urinary bladder. Although these myomas do not prevent pregnancy, they can grow during pregnancy and cause unwanted problems during pregnancy, such as premature birth pains and pain.
3. Subserous Myomas
These are myomas that grow towards the outer surface of the uterus. They cause symptoms such as abdominal pain, backache, feeling of fullness, frequent urination, and constipation. They do not cause bleeding problems. They do not prevent pregnancy, but they can grow during pregnancy, such as intramural myomas, which are located within the uterine muscle tissue, and can cause unwanted problems during pregnancy, such as premature birth pains and pain.
How Do Myomas Cause Infertility?
Myomas affect reproduction. Its possible effects on its functions have been tried to be explained in many ways. Myomas can cause changes in uterine contractions and blood supply, and can negatively affect sperm transport and the implantation of the embryo in the uterus. It is also suggested that myomas cause changes in the microvasculature in the uterine muscle wall, disrupting the tight bonds between cells and affecting the formation of regional growth factors necessary for vascularization. It is thought that these changes caused by myomas may negatively affect the implantation of the embryo in the uterus.
Anatomically, while myomas enlarge the uterus and disrupt the uterine cavity, they change the surface area and boundaries of the cavity and may block the channels of the tubes opening into the uterus or the cervical canal. They can change the position of the cervix. These acquired structural disorders may disrupt the transport of sperm, egg or embryo, preventing the embryo from settling in the uterus and pregnancy. In addition, myomas can cause contractions in the uterine muscle wall, preventing the embryo from moving and settling in the uterus. Myomas also disrupt the vascularity in the endometrium, which is the inner wall of the uterus that covers them, causing inflammation, ulceration, thinning and atrophy, which prevents the embryo from settling. They can hinder your inspiration.
In Which Circumstances Should Surgery Be Performed?
Submucous myomas that grow towards the inner cavity of the uterus, intramural myomas that are embedded in the uterine wall but arching towards the inner cavity of the uterus, and large myomas negatively affect the results of in vitro fertilization and in vitro fertilization. These myomas must be removed before treatment. Myomas on the outer surface of the uterus do not have a negative effect on reproductive functions and surgery is not recommended. In patients with small myomas located within the uterine wall, if there is a good ovulation response, recurrent pregnancy failures despite quality embryos, or in cases of early pregnancy loss, removal of these myomas may increase the chance of getting pregnant.
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