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Cysts and fibroids

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Cysts

Cysts are very varied. Fortunately, most of them are completely harmless, disappear on their own and have no influence on the ability to have children.


However, since hormone changes during pregnancy and hormonal fertility treatment can cause problems with the cysts, all types should be examined by a doctor beforehand, otherwise they could continue to grow and, instead of receding, interfere with the maturation of the eggs.


The few types of cysts that do interfere with fertility must be removed if you wish to have a child. These include:


  • Chocolate or tar cysts: these develop as a result of endometriosis.


Endometriosis tissue is located in different organs and behaves like uterine tissue; the tissue that lines your womb. Therefore, it can bleed in a cycle-related manner. However, since the blood has no way to drain, cysts form as a result. They are called cysts because of their dark colouring, hense the name "chocolate" or "tar". As these cysts lead to adhesions or twisting of the fallopian tubes (see stuck fallopian tubes) and the ovaries, they often have to be removed surgically by laparoscopy.


  • Fast-growing cysts: Cysts can develop on the ovary that do not disappear through the normal cycle but steadily increase in size.


These cysts can lead to abdominal pain and loss of function of the ovary. They also carry the risk of cyst rupture or rotation of the ovary. Therefore, fast-growing cysts should be removed by laparoscopy to avoid emergency situations.


  • Polycystic ovaries are a symptom of PCO syndrome (PCOS), a hormonal disorder preventing the maturation of the egg cells. As a result, ovulation does not occur and the woman cannot become pregnant. The immature egg follicles accumulate as cysts in the ovary, which can subsequently grow to three times its original size. These cysts do not regress on their own, but can be reduced surgically by laser drilling. This alone can lead to regular ovulations. Alternatively, there are effective hormone treatments for PCO syndrome.

Fibroids

Fibroids, on the other hand, are muscle tissue-like lumps in or on the uterus and are very common. It is more than possible for a woman with fibroids to become pregnant naturally. Not all of them interfere with fertility.


However, if fibroids are located in a sensitive part of the uterus (e.g. directly under the lining of the uterus), they can prevent or interfere with a desired pregnancy. Sometimes their sheer size interferes with the desire to have a child. In such cases, they are surgically removed (myoma enucleation).



Subserous fibroids: Fibroids on the outside of the uterus (subserous fibroids), for example, usually have no effect on the desire to have a child. Whether they need to be removed before a planned pregnancy depends on their size or whether they cause discomfort. If they do need to be removed, they can usually be removed easily with an endoscopy.


Intramural fibroids: Fibroids that are located inside the uterine wall (intramural fibroids) will probably only affect fertility or embryo implantation if they exceed 3 to 4 centimetres in size. However, if they reach this critical size, they should be removed if you wish to have a child. Sometimes this is possible by means of endoscopy. If they are too deep in the wall, they have to be removed through a larger abdominal incision.


Submucous myomas: Myomas that grow into the uterine cavity (submucous myomas) usually interfere with the implantation of an embryo, regardless of their size. Such fibroids are therefore removed in an outpatient operation by means of a uterus endoscopy with an electric snare.


Depending on which surgical method was used and where the fibroid was located, you should wait up to 6 months before fertility treatment or trying to get pregnant in general. The uterine organ should have time to regenerate.


Since even harmless fibroids can grow under the influence of hormones, for example during oestrogen and progesterone stimulation and during pregnancy, it is then necessary to decide individually how to proceed. The attending physician will keep a constant eye on fibroids.

Alternative treatments for fibroids


In addition to endoscopy and outpatient surgery, other treatments have been developed: To remove or prepare for surgery.



Drug treatment with ulipristal acetate (Esmya) can lead to significant shrinkage of the fibroid and suppresses the menstrual cycle for the duration of the treatment. This therapy is only approved as hormonal preparation for surgical myoma removal. Because used on its own, drug treatment is not enough to improve the chance of pregnancy.


In embolisation of the myoma vessels, a catheter is inserted into the blood vessel supplying the myoma under X-ray control and thus closed off. The myoma tissue, which is no longer supplied with blood, therefore remains in the body. Depending on the size and location of the embolised myoma nodes, they can still make it difficult for an embryo to implant in the uterus. This method is therefore not necessarily suitable if you wish to have a child.


Another method is MrgFUS (magnetic resonance focused ultrasound MR-HIFU). Myoma tissue is sclerosed by ultrasound without surgery. A magnetic resonance tomography with contrast medium must be carried out beforehand. The treatment itself is also carried out in an MRI scanner without a general anaesthetic in the prone position and can take several hours. Long-term pain treatment is often necessary afterwards. How this therapy affects fertility and subsequent pregnancies has not yet been sufficiently researched and is therefore also rather unsuitable for those who wish to have children. The therapy is also unsuitable if there are a large number of fibroids or pedunculated fibroids. Moreover, it is only paid for by a few statutory health insurance funds.

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