First, the three core factors that fibroids affect test tubes
1. Location determines risk level
Intramural myoma: If it does not compress the uterine cavity or has a diameter of less than 5cm, the impact will be small; if it protrudes towards the uterine cavity or is more than 5cm, it may lead to deformation of the uterine cavity and obstruction of blood flow in the intima.
Subserosal fibroids (outgrowth): They usually do not affect IVF unless they are too large to compress the fallopian tubes.
2. Critical values for size and quantity Low risk: Single fibroid diameter <5cm, or multiple fibroids do not affect the uterine cavity shape.
High risk: The diameter of fibroids is ≥ 5cm, the number is ≥ 3, or the total volume is> 100cm ³, and the risk of premature delivery increases.
3. Superimposed effect of symptoms and age If fibroids cause menorrhagia, anemia or abdominal pain, pregnancy tolerance can be reduced
Elderly patients (> 35 years old) need to assess the cumulative risk of fibroids to pregnancy more carefully due to reduced ovarian function.
1. Implantation stage
Submucosal fibroids change the uterine cavity microenvironment Large fibroids between the muscles compress the intima, leading to an increased risk of biochemical pregnancy after embryo transfer.
2. Pregnancy maintenance stage Elevated estrogen during pregnancy may stimulate the growth of fibroids, causing pain, degeneration or placental rapture
Myomas located at the attachment of the placenta can increase the probability of abortion and fetal growth restriction.
(1) Situations requiring priority surgery
n (Any big or small)
t Straight diameter ≥ 5 cm t Myoma causes anemia or reflux production n Note: GnRH-a drugs can be used to treat the size of small myoma before surgery. | ||
(2) The situation where the test tube can be directly tried Subserosal myoma or small intermural myoma (diameter <5cm)
Multiple fibroids that are asymptomatic and do not affect the shape of the uterine cavity.
Precautions: During ovulation promotion, B-ultrasound should be used to monitor the changes of fibroids every 2 weeks to avoid rapid growth caused by hormone stimulation. 4. Expert consensus and patient suggestions
1. Must check items before pregnancy
Three-dimensional ultrasound or MRI: Accurately locate the relationship between fibroids and uterine cavity Hysteroscopy: Assess endometrial receptivity and exclude submucosal fibroids.
2. Risk management in the test tube cycle Ensure that the intimal thickness is ≥ 8 mm and the blood flow is abundant before transplantation
Myoma is monitored every 4 weeks after pregnancy, and timely intervention is required if abdominal pain or bleeding occurs.
3. Special population plan Elderly patients: If ovarian function declines, the eggs can be removed and frozen first, and the embryos can be processed before transplanting
Those who refused surgery: Try GnRH-a to control fibroids, but be wary of side effects such as osteoporosis.
Zhang Qing, deputy chief physician of Qilu Hospital of Shandong University, emphasized: "Submucosal fibroids and intramural fibroids of> 5 cm are the 'red lines' of test tubes and must be treated first.However, patients with subserous fibroids do not need to worry too much, and the success rate is not significantly different from that of healthy people."
Accurateevaluation turns "tumors" into opportunities
Uterine fibroids are not an absolute taboo for test-tube babies, but a synergy factor in fertility that requires refined management. Through precise preoperative classification, individualized control of surgical indications and strict monitoring during pregnancy, most patients can still achieve healthy childbearing. As Dr. Huang Yazhen said: "The key to myoma management is not 'there is' but 'where' and 'whing'."
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