Fibroids and Reproduction

Description:

The most common abnormal growth of the female reproductive system, fibroids, are thought to affect the majority of women at some point during their reproductive years. This text from leading fibroid experts looks at the latest evidence on how the problem impinges on reproduction and the most up-to-date management and treatment options available to help patients with fibroids hoping to conceive. Print versions of this book also include access to the digital version with links to procedural videos.

Table of Contents:

1. Fibroids and Reproduction: A Bird’s-Eye View

Introduction

Classification

Diagnosis

Fertility

Conception

Miscarriage

In Vitro Fertilization Outcome

References

2. Fibroids and Assisted Reproduction Technology

Introduction

Risk Factors

Classification

Fibroid and Assisted Reproduction Technology Outcomes: Current Evidence

Subserosal Fibroids

Intramural Fibroids

Submucosal Fibroids

Treatment of Fibroids from the Fertility Aspect

Surgical Treatment

Surgery for Submucosal Fibroids

Surgery for Intramural Fibroids

Alternatives to Surgical Interference

Uterine Artery Embolization

GnRH Agonists

Selective Progesterone Receptor Modulators

Algorithms for Fibroid Management

Type 0 Myomas

Type 1 and 2 Myomas

Types 3 through 5 Myomas (Single or Multiple)

Conclusion

References

3. Fibroids and Endometrial Receptivity/Embryo Implantation

Introduction

Implantation

Normal Steps of Implantation

Endometrial Receptivity

Fibroids and Endometrial Receptivity

Mechanical Disruptors

Disruption of Implantation

Angiogenic and Vascular Factors

Immunologic and Inflammatory Factors

Impact on Gene Expression

Conclusion

Research and Future Therapeutics

References

4. Uterine Fibroids and Recurrent Pregnancy Loss

Introduction

Fibroids and Pregnancy Loss

Fibroids and Recurrent Pregnancy Loss

Evaluation of Anatomic Factors in Recurrent Pregnancy Loss

Treatment

Medical Management

Procedural Options

Hysteroscopic Myomectomy

Laparoscopic and Abdominal Myomectomy

Conclusion

References

5. Fibroids in Pregnancy

Introduction

Prevalence

Changes in Size during Pregnancy and Postpartum

Symptoms

Complications

Management Issues

Management of Patients with Prior Myomectomy

References

6. Medical Options for Uterine Fibroids in the Context of Reproduction

Introduction

Risk Factors of Uterine Fibroids

Race

Reproductive Factors

Obesity

Vitamin D Deficiency

Hormonal Effects

Uterine Fibroids Management

Hysteroscopic Myomectomy

Laparoscopic Myomectomy

Uterine Artery Embolization

Pharmacological Therapies for Uterine Fibroids

Combined Oral Contraceptives

Levonorgestrel-Releasing Intrauterine System

Progestogens

Selective Progesterone Receptor Modulators

Gonadotropin-Releasing Hormone Agonist

Developing New Medical Treatment for Uterine Fibroids

Nonpeptide Oral Gonadotropin-Releasing Hormone Antagonists

Conclusions and Future Directions

Conflict of Interest

References

7. Fibroid Preoperative Imaging: Ultrasound

Introduction

Ultrasound Technique

Two-Dimensional Ultrasound

Three-Dimensional Ultrasound

Saline Infusion Sonohysterography

Hysterosalpingo Contrast Sonography

Color Doppler

Magnetic Resonance Imaging

Establishing a Correct Diagnosis via Ultrasound

Ultrasound Features of Fibroids

Ultrasound Features of Various Differential Diagnoses

Adenomyosis

Diffuse Uterine Leiomyomatosis

Endometrial Polyps

Ovarian Fibromas

Leiomyosarcoma

Disseminated Peritoneal Leiomyomatosis

Proper Reporting of Ultrasound Findings

Conclusion

References

8. Fibroid Preoperative Imaging: Magnetic Resonance Imaging

Introduction

Magnetic Resonance Imaging Techniques

Magnetic Resonance Imaging Features of Uterine Leiomyomas and Differential Diagnosis

Classification of Uterine Leiomyomas and Implications for Management

Conclusion

References

9. Interventional Procedures

Introduction

Uterine Artery Embolization

Procedure Specifics

Short-Term Outcomes

Long-Term Outcomes and Reintervention

Risks

Pregnancy Afterward

Magnetic Resonance–Guided Focused Ultrasound

Procedure Specifics

Short-Term Outcomes

Long-Term Outcomes and Reintervention

Risks

Pregnancy Afterward

Radiofrequency Ablation

Procedure Specifics

Short-Term Outcomes

Long-Term Outcomes and Reintervention

Risks

Pregnancy Afterward

Conclusion

References

10. Hysteroscopic Myomectomy

Evolution of Hysteroscopic Myomectomy

Significance of Submucosal Fibroids

Preoperative Imaging

Patient Selection

Preoperative Considerations (Cervical Ripening, Antibiotics, Venous Thromboembolism Prophylaxis)

Consents

Surgical Steps, Intraoperative Considerations, and Complication Prevention

Instruments, Devices, and Special Techniques

Office Myomectomy

Postoperative Care

Outcomes (Recurrence, Fertility, Adhesions)

Conclusion

References

11. Laparoscopic and Robotic-Assisted Myomectomy

Patient Evaluation and Selection

Preoperative Management

Consents and Outcomes

Preoperative Prophylaxis

Instrumentation

Surgical Steps

Additional Intraoperative Considerations

Postoperative Care

Laparoscopically Assisted Myomectomy

Robotically Assisted Myomectomy

Intraoperative Ultrasound Guidance

References

Index