40w LaterGuide

One of the most common conditions affecting the uterus is uterine fibroids (leiomyomas).

Uterine fibroids are benign tumors that develop from the muscle layer of the uterus. They are common and may cause symptoms such as heavy or prolonged menstrual bleeding, pelvic pressure, or menstrual pain, although many women have no symptoms.

Whether fibroids affect fertility depends largely on their size and location.

In particular, submucosal fibroids, which grow into or distort the uterine cavity, are more clearly associated with reduced fertility and may interfere with embryo implantation.

Other uterine conditions that may affect fertility include adenomyosis, in which tissue similar to the uterine lining grows within the muscle of the uterus, and endometrial polyps, which are growths arising from the lining of the uterine cavity.

These conditions can often be evaluated with transvaginal ultrasound, although additional tests such as saline infusion sonohysterography, hysteroscopy, or MRI may sometimes be needed.

How are uterine conditions treated?

If a submucosal fibroid or endometrial polyp is thought to be interfering with fertility, it may be removed through hysteroscopic surgery, which allows the doctor to treat the lesion through the cervix while preserving the uterus.

Not every fibroid or uterine abnormality requires treatment. The decision depends on symptoms, size and location, age, fertility plans, and other individual factors.

What about ovarian abnormalities?

Ovarian cysts are common and have many different causes. One condition that can be particularly relevant to fertility is an ovarian endometrioma, a cyst associated with endometriosis.

Endometriosis can cause inflammation and adhesions around the ovaries, fallopian tubes, and other pelvic organs. These changes may interfere with normal reproductive function and can contribute to infertility.

An endometrioma often contains thick, dark-brown fluid, which is why it is sometimes called a “chocolate cyst.”

Endometriomas can usually be identified with ultrasound, although additional evaluation may occasionally be required.

Does an endometrioma always need surgery?

No. Surgery may be considered when the cyst is large, causes significant pain, has unusual features, or when there are other clinical reasons for removal.

However, surgery on an endometrioma can sometimes reduce ovarian reserve because healthy ovarian tissue may also be affected during removal.

For women who are trying to conceive, the decision between surgery, trying for pregnancy, or proceeding with fertility treatment should therefore be individualized based on age, ovarian reserve, symptoms, cyst characteristics, and the overall fertility plan.