Fibroids are benign formations of myometrial tissue, more or less spherical, which can be located in different parts of the uterus. Fibroids that are located inside the uterine cavity (submucous) are removed before IVF trans-hysteroscopically.
If it is a myoma that protrudes outside the uterus (subserosal), it does not usually cause any problems in pregnancy, so it is not treated.
Finally, fibroids that are inside the wall of the uterus are called intramural fibroids. Some of them can contact or deform the endometrial cavity, which can impair the correct implantation of the embryos and their subsequent growth.
Once we have evaluated whether or not a myoma should be treated before IVF, we can hesitate about the type of treatment.
Myomectomy (surgical removal of the myoma) is the most commonly used technique, but it carries the risks inherent to surgery (excessive bleeding, infection, scar tissue, hysterectomy, uterine rupture in childbirth, etc.). We will have to wait a few months to do an embryo transfer.
Uterine artery embolization consists of closing the vessels and therefore the irrigation of the fibroids. It is performed by inserting a catheter through the femoral artery to the uterine arteries guided by X-rays. Once there, microparticles are expelled which prevent irrigation of the myoma, which then necroses and decreases in size.
This technique was used above all in postpartum hemorrhages, perimenopausal women, with abundant bleeding or pre-surgery. But arterial embolization has been used for years to treat fibroids in patients who want to keep their uterus.
This also has its risks (treatment failure, bleeding, infection, scar tissue, some cases of ovarian or endometrial involvement, uteroplacental insufficiency...).
The decision as to which form of treatment to carry out will depend on each particular situation, on the size, number and position of the myoma, etc.
