Minimally Invasive Laparoscopic Fibroid Removal For Fertility
FIBROIDS CAN AFFECT FERTILITY IF NOT REMOVED
African American women are two to three times more likely to have recurring fibroids — and are three times more at risk of pregnancy-related complications. When initially diagnosed with fibroids in 2008, pregnancy wasn’t top of mind for Raynelle.
“At first, I didn’t know anything was wrong,” said Raynelle. “I did not have any symptoms from my fibroids. I would get normal period pain, occasionally. During an exam, my uterus didn’t feel quite right, so my OBGYN sent me for a sonogram.”
Aside from some mild back pain, Raynelle wasn’t experiencing many of the common symptoms like severe pain, heavy bleeding, or anemia. Many women are unaware that a quiet symptom of fibroids is that it can get in the way of fertility or carrying a child safely to term. In Raynelle’s case, her fibroids weren’t affecting her daily life and her OBGYN recommended she watch them and wait, but as she discovered years later, they posed a threat to her ability to carry a baby without complications.
Early detection and minimally invasive fibroid removal is the most effective treatment for women who suffer with painful, prolonged, or heavy periods. However, many OBGYNs or general practitioners advise women to watch, wait, and let them know if their symptoms change. This can be subjective, as a patient may not know what to look for if the fibroids aren’t causing overt or rapid changes.
Watching and waiting to treat fibroids is an out-of-date practice. The specialists at The Center for Innovative GYN Care (CIGC®) often see patients with fibroids that could have been removed when they were small. Too often, women accept that pelvic pain and heavy bleeding are normal. Pelvic pain and abnormal bleeding are signs of complex GYN conditions. However, in Raynelle’s case, she had minimal symptoms while her fibroids continued to grow. Even in the absence of disruptive symptoms, when diagnosed with fibroids, it is essential to have them removed early.
INFERTILITY: THE SILENT SYMPTOM OF FIBROIDS
Fibroids are one of many possible causes of infertility. The location, and not necessarily the size, is often a major consideration. However, large fibroids can block fallopian tubes, not allowing an embryo to pass into the womb, or create uterine distortion so that an embryo is not able to properly attach to the womb. Submucosal fibroids, those in the uterine cavity, and intramural fibroids, those within the uterine muscle, are the most troublesome for fertility.
During pregnancy, fibroids can grow simultaneously with the baby. The increased blood flow to the uterus to help sustain a growing baby can also feed the fibroids. Miscarriages and preterm births can also occur. Depending on the placement, fibroids can cause placental abruption, detaching the placenta from the uterine lining, and can also create barriers to delivery if a fibroid blocks the birth canal, forcing emergency cesarean sections.
Raynelle had started discussing the idea of having children with her husband. “I realized that I needed to get checked out. My OBGYN said that the fibroids were now the size of a small grapefruit or an orange, and there would be no room in my torso for them and a baby. She recommended an open myomectomy.”
LAPAROSCOPIC FIBROID REMOVAL TO PREVENT FIBROID-RELATED INFERTILITY
Open fibroid removal procedures can take six to eight weeks of recovery and require a large incision. It can be hard to control bleeding during these procedures. While fibroid removal can be done with an open procedure, patients experience a great deal of pain during the long recovery. Robotic or other laparoscopic fibroid removal procedures can also take a long time to perform, and they are not able to remove all types of fibroids. In the instance there are obscure fibroids present, this type of procedure will not allow the surgeon to feel for additional tumors that may not appear on imaging. Both open and robotic myomectomies have a higher incidence of complications and often require additional surgeries to repair delicate structures.
“I have an analytical nature. I went for a second opinion and that doctor said the same thing, open myomectomy, four to six week recovery. Then it hit me, this isn’t just a ‘to-do’ to check off. It’s a big deal to have a child,” said Raynelle. “At first, it was pragmatic decisions – how much does it cost, what kind of surgery, etc. Then I slowed down and started feeling the weight of what I was deciding to do.”
Women with fibroids trying to get pregnant can now find experienced, state-of-the-art options that weren’t previously available. Modern minimally invasive fibroid removal techniques used by GYN specialists can be performed in outpatient settings with patients returning to work in two weeks or less. A Laparoscopic Assisted Abdominal Myomectomy or LAAM-BUAO® procedure developed by the minimally invasive surgical experts at CIGC takes the best of both open and laparoscopic procedures, for a safer, more thorough surgery that has a faster recovery with less pain. The uterus is repaired by hand in layers so that, as it heals, it is strong enough to carry a baby to term.
Between not being able to schedule an appointment with her OGBYN and the concern of taking off four to six weeks for surgery, Raynelle was open to better options. “My mother, my husband, my sister, my mother-in-law – anyone who had a stake in me getting pregnant – all started doing research and talking to friends. Two separate sources recommended CIGC. Finding a more convenient, less invasive approach was the perfect solution at the right time.”
Raynelle booked her consultation with Natalya Danilyants, MD, co-founder of CIGC. The first visit made her decision clear.
GETTING TO KNOW DR. NATALYA DANILYANTS, MD
“Within a three to four minute conversation with Dr. Danilyants, I had a better understanding of how my body worked than I had after eight years worth of conversations with my regular OBGYN,” said Raynelle. “It was clear that she was top notch, but she was so humble when we talked. I looked up her bio afterward and realized she had some impressive credentials as Chief Resident at George Washington University, where I also went to graduate school, and Division Chief of Minimally Invasive GYN Surgery at Inova Fair Oaks Hospital. I was in amazing hands.”
Raynelle was impressed with CIGC and felt confident in Dr. Danilyants and the minimally invasive approach. She proceeded to book an appointment right away.
“I have family in the area, so I was able to stay with them for the rest of that week. I went back to work a week later. I could have gone back before then. That Sunday, I was at the Ravens/Steelers game in Baltimore.”
RECOVERY AND RAYNELLE’S PATH TO MOTHERHOOD
Raynelle’s surgery revealed four additional fibroids, six in total. Dr. Danilyants was able to remove all of them but suggested that when she was ready to get pregnant, to move forward with a cesarean section, as the surgery was more in-depth than expected.
The Monday after her surgery, Raynelle was already back at work and feeling well — she experienced some bloating but very minimal pain and stopped taking her pain medication early. A year after her surgery, Raynelle and her husband were ready to start trying for a baby. Before she started tracking her cycle, Raynelle decided to take a pregnancy test and found that she was already pregnant!
Her pregnancy after surgery was a smooth and easy process. She felt no pain and had no morning sickness. Raynelle’s daughter, Emerson, was born via C-section, through which they used her laparoscopic myomectomy incision to deliver.
Today, Raynelle has a beautiful and healthy child and no evidence of her fibroids or fibroid removal surgery.
BOOK A CONSULTATION
The CIGC state-of-the-art specialists are available at three locations in the DC metro area. Virginia patients can visit the Reston, VA location, and Saturday appointments are available. Maryland offices are located in Rockville, MD and Annapolis, MD.
CIGC is dedicated to providing information and materials for women to help navigate the complicated healthcare system. The CIGC founders, minimally invasive GYN surgical specialists Dr. Paul MacKoul, MD and Dr. Natalya Danilyants, MD, developed their advanced GYN surgical techniques using only two small incisions with patients’ well-being in mind.
Their personalized approach to care helps patients understand their condition and the recommended treatment so that they can have confidence from the very start. Our surgeons have performed over 20,000 GYN procedures and are constantly finding better ways to improve outcomes for patients.