1. Key points of the impact of uterine fibroids on test-tube babies

1. The location of the fibroid determines the risk level
·Submucosal fibroids (type 0-2): They project towards the uterine cavity, directly invade the embryo implantation space, significantly reducing the success rate of test tubes, and need to be treated first.
· Intramural fibroids (types 3-5): If the diameter of the fibroids exceeds 4 cm, or if they compress the endometrium, they may alter the shape of the uterus and affect blood flow. Therefore, it is necessary to evaluate the situation on a case-by-case basis.
Subserosal fibroids (types 6-8): These grow outward and generally do not affect the uterine cavity environment. They can be left untreated for now.
·Estrogen stimulation during pregnancy causes the rapid expansion of fibroids, causing red degeneration (abdominal pain, risk of abortion).
·During pregnancy, estrogen stimulation can cause fibroids to grow rapidly, leading to red degeneration (pain in the abdomen, increased risk of miscarriage).
·Large fibroids may compress the fetus, increasing the risk of premature birth, cesarean delivery, and postpartum hemorrhage.
1. Comprehensive examination to determine the characteristics offibroids
·Required items: transvaginal ultrasound (positioning and sizing), hysteroscopy (assessment of uterine cavity shape).
·Items to be checked: Transvaginal ultrasound (for positioning and measurement of size), hysteroscopy (for assessing the shape of the uterine cavity).
·Advanced assessment: MRI (for complex cases) or 3D ultrasound, to clearly determine the spatial relationship between fibroids and the endometrium and myometrium.
·You can try to test tubedirectly
Submucosal fibroids <2cm andasymptomatic
The intramural myoma is less than 4cm and far away from theintima
Subserosal fibroids regardless of size.
Subserosal fibroids, regardless of their size,
Submucosal fibroids ≥2cm
Intramural myoma ≥4cm or compresses the intima
Multiple fibroids cause severe deformation of the uterine cavity.
Multiple fibroids can cause severe deformation of the uterine cavity.
1. Surgicaltreatment
·Hysteroscopic surgery: It is suitable for submucosal fibroids with minimal trauma. Pregnancy can be tested 1-3 months after surgery.
·Hysteroscopic surgery is suitable for submucosal fibroids. It involves minimal trauma, and women can try to conceive again 1-3 months after the operation.
·Laparoscopic/open surgery: For fibroids located within the muscular wall or subserosal layer, contraception is required for 6-12 months after the operation (depending on the depth of the fibroid).
·High-intensity focused ultrasound (HIFU): Non-invasive ablation of fibroids can enter the test-tube cycle 3-6 months after surgery. It is suitable for patients with deep fibroids and high surgical risks.
·High-intensity focused ultrasound (HIFU): A non-invasive method for destroying fibroids. Patients can resume IVF treatment 3-6 months after the procedure. This method is suitable for patients whose fibroids are located deep within the body, and who face high surgical risks.
·GnRH-a drugs: They can reduce the size of fibroids by an average of 30%-50%. They also help control symptoms. However, it is necessary to stop using these drugs 1-2 months before undergoing ovulation induction procedures.
1. Timing of egg retrieval and fibroidtreatment
·Priority egg retrieval: If the fibroids require surgery and the patient's ovarian reserves are good, the egg retrieval can be completed first, and the embryos can be frozen before processing the fibroids to avoid a decline in ovarian function.
·Priority egg retrieval: If the fibroid requires surgery and the patient has a good ovarian reserve, ovulation induction and egg retrieval can be performed first. The embryos can then be frozen, allowing for later treatment of the fibroid. This approach helps to prevent a decline in ovarian function.
·Postoperative transplantation should be performed as soon as possible after the operation. It is recommended to transplant the tissue within 3 to 6 months after surgery, in order to minimize the period of endometrial repair.
·Single embryo transfer: Reduce the risk of multiple pregnancies, especially for people with limited uterine conditions.
·Single embryo transfer: reduces the risk of multiple pregnancies: particularly suitable for those with limited uterine conditions.
·Endometrial preparation plan: The medication used should be adjusted according to the location of the fibroids. For example, the dosage of estrogen can be modified to improve endometrial receptivity.
1. Focus on postoperativeconditioning
·Nutritional support: Supplement iron (anti-anemia), vitamin D (promoting calcium absorption), and avoid spicy, high-estrogenic foods.
·Nutritional support: It is necessary to supplement with iron to prevent anemia, as well as vitamin D to promote calcium absorption. Also, it is important to avoid spicy foods and those high in estrogen.
·Regular monitoring is necessary: starting 3 months after surgery, undergo ultrasound examinations every 3 to 6 months to observe any signs of regeneration.
·Control weight (BMI<24) and reduce obesity-related estrogen secretion.
·Maintain a healthy weight (BMI< 24), and reduce the secretion of estrogen related to obesity.
·Long-term management: Traditional Chinese medicine treatments (such as formulas for promoting blood circulation and removing stasis) or Western medical interventions (oral contraceptives) can be used to inhibit the growth of fibroids.
·Priority for fertility preservation: Women over the age of 35 are recommended to freeze the embryos first to avoid delaying the appropriate childbearing opportunity due to fibroid treatment.
·Reproductive capacity preservation is of utmost importance: Women over the age of 35 are advised to freeze their embryos in advance, to avoid delaying the optimal time for reproduction due to treatments related to fibroids.
·Multidisciplinary collaboration: The Department of Reproductive Medicine, Department of Gynecology, and Department of Ultrasound collaborate to develop comprehensive treatment plans, ensuring a balance between the management of fibroids and the preservation of ovarian function.

In the game between uterine fibroids and test-tube babies, scientific evaluation and precise intervention are the key. No matter which plan is chosen, personalized treatment must be the core and the advice of a professional medical team must be combined to create a suitable environment for embryo implantation. The road to childbirth may be tortuous, but rational planning will eventually usher in the dawn.