Uterine Fibroids - Hysteroscopic Treatment and Fertility

Uterine fibroids (UFs) are common benign tumours of the female genital tract, diagnosed in almost one-quarter of women of reproductive age. UFs may cause numerous clinical symptoms, including prolonged or heavy menstrual bleeding, pelvic pressure symptoms, pain, infertility and others. Various mechanisms have been proposed to explain the impact of each of them on reproductive outcome. Current evidence implies that submucosal myomas, that arise from the muscular part of the uterus and pen-etrate into the uterine cavity, have an adverse effect on conception and early pregnancy. They are mostly managed with the use of hysteroscopic myomectomy (BM), which provides direct visualization from the transcervical approach. HM is a safe and effective treatment in patients with the normal size of the uterus and with no more than a few UFs. The procedure should not be initiated without adequate preparation and diagnosis, using the best methods available. A similar effect has been suggested for intramural myomas. It seems reasonable that intramural myomas greater than 4 cm in diameter may negatively impair reproductive outcome. In particular increased risk for miscarriage, fetal malpresentation, placenta previa, preterm birth, placenta abruption, postpartum haemorrhage, and caesarean section has been reported.