Navigating Fibroids and Polyps in Fertility: Insights from HSG Analysis – ARC Summit
I’m going to discuss the interpretation of HSGs, particularly focusing on the identification of uterine pathologies such as fibroids and adenomyosis, which are common findings during these evaluations. Initially, capturing the right images is crucial. Although my nurse practitioners take numerous pictures during an HSG, the most critical are the initial ones where the uterus is first filled. These images often reveal significant findings like fibroids, which may be overlooked if the focus is solely on the fallopian tubes.
For instance, during one procedure, an apparent fibroid was visible in the initial filling of the uterus, but it became obscured once the dye fully opacified the cavity. This highlights why the first image is essential. Additionally, proper imaging technique is vital. I emphasize the importance of applying traction to straighten the uterus, which helps avoid distorted views that can complicate the diagnosis. While some practitioners may use a filled balloon for this purpose, I find manual traction to be more effective and less uncomfortable for the patient.
In terms of pathology, it’s not just about identifying fibroids but also considering adenomyosis, especially when you see typical infiltration patterns in the imaging. This condition should always be included in the differential diagnosis, particularly when evaluating fertility issues.
Moving on to the management of fibroids, the decision to operate is guided by several factors: the fibroid’s size, location, and the patient’s symptomatology. For fertility purposes, fibroids larger than 6 cm, especially those intramural or submucosal, are typically considered for surgical removal due to their potential impact on fertility. However, for smaller or asymptomatic fibroids, especially in locations less likely to affect fertility or pregnancy, conservative management is often adequate.
In treating fibroids, I take into account the patient’s age, symptoms, and reproductive goals. For instance, older women with asymptomatic fibroids who are pursuing fertility treatments like IVF may not benefit from fibroid removal if other more significant reproductive challenges are present. Conversely, younger women or those experiencing significant symptoms from fibroids, such as heavy menstrual bleeding or pelvic pain, might benefit more from surgical intervention.
Ultimately, the decision to perform a myomectomy should be a thoughtful dialogue between the physician and patient, considering all aspects of the patient’s reproductive health and personal circumstances. Each case is unique, and the approach must be tailored to the individual’s needs and clinical findings.
