This is a sad but very honest posting. We recently had a prospective patient that decided not come for our surgery because we would not guarantee fertility after fibroid tumor surgery. No surgeon can give that guarantee. We told her our philosophy was to remove her tumors without leaving any intentionally, offer a video viewing of her surgery to ensure we did everything possible, with no blood transfusions and no hysterectomy….she elected to go to a local gyn who promised all the same things AND fertility. Sadly, we heard the day after surgery that the bleeding was to intense they had to stop the surgery and left several large tumors….although transfusion was suggested and warranted, the gyn elected not to. The patient had to stay three extra days due to dangerously low blood pressures and dizziness…had multiple fainting spells once discharged home and was unable to have visitors for 2 weeks due to weakness. They have recommended IVF treatments to attempt fertility in a few months. This is just bad medicine….this patient was promised something that could not be delivered…and suffered in the process. Fertility is once again in question and she will no doubt require more fibroid tumor surgery. Make sure you know what your surgeon is capable of..the procedure you are having and the potential complications.
Traditional medicine has routinely rcommended removal of the uterus, hysterectomy, for uterine and ovarian malignancy, however physicians also advocate hysterectomy for benign diseases like fibroids, adenomyosis, and endometriosis. Recent studies (LA Times article, published August 10, 2009 entitled “Staying Fertile after Cancer”) on Stage 1 ovarian cancer patients have found that preserving the uterus and unaffected ovary have the same 5 year survival rates as removing all organs. If medicine is changing to reduce hysterectomies for certain cancers, lets hope they will eventually see the need to prevent hysterectomy for benign diseases as well.
Young women might be able to preserve their fertility despite a diagnosis of ovarian cancer. Recent studies, based on a publication this month in Cancer, have found that 5 year survival rates are the same for both patients that remove all female organs (both ovaries and uterus) and those that only removed the affected ovary. This is strictly for early diagnosed Stage 1 (one) malignancies in premenopausal women . This is great news for women hoping to preserve their female organs. Regardless of fertility desires, prematurely removing the uterus and ovaries can thrust women into early menopause. This can expose the woman to all the negative side effects of early castration: hot flashes, dry vagina, osteoporosis, heart disease and early death and dementia. Ask your doctor is you can be a candidate to preserve your female organs.
Fibroid tumors are benign solid tumors of the uterus.
Many women can get pregnant and carry to term with these tumors. The outcome
is often dependent on 3 factors: the size of the fibroids, the number of the fibroids and the specific location of the tumors. The greater the size, and the greater the number, will decrease chances of fertility. Location is also vital for outcome. Tumors that are deep within the intramural area of the uterus or those impinging on the endometrial cavity can and often produce miscarriage. If you get a diagnosis of Fibroids, do not wait for treatment. Have them removed as soon as possible.
After the blog last week, we had many emails regarding the treatments for fibroid tumors in relation to fertility options. There is no way to “guarantee” fertility with surgery. No doctor can do that. What your doctor can do is safely remove your tumors.
IF you have multiple or large fibroids your chances of fertility will become less over time or impossible, if you do nothing.
Removing the fibroids may also prevent fertility just by cutting the uterus to remove the tumors.
IF you have fibroids and are contemplating a pregnancy, check with a fertility specialist.
Sometimes the only option for treatment is a surgical removal of the tumors….but that does not always
ensure fertility after surgery.