I am 30 years old and suffered a miscarriage with my first pregnancy in May. A 10cm fibroid was discovered at this time. The fibroid is still 5cm, and my doctor is recommending a myomectomy. I wish to have a family. Will this surgery inhibit my chances of having a successful pregnancy?

A.L.

Fibroids are benign smooth muscle tumors that can interfere with the blood supply to the inner uterine lining (endometrium). While smaller fibroids are likely to cause no problems during pregnancy, a large fibroid can distort the uterine cavity and increase the risk of miscarriage.

Removal of fibroids (myomectomy) is most often a technically simple surgery. As such, risk of surgical complications is low. Risks increase with the size of the uterus and the number of fibroids being removed. Surgeons are cautious to use gentle surgical techniques to minimize the risk of adhesion (scar tissue) formation, which may hinder your chances for pregnancy in the future. I often use an adhesion barrier -- an adhesion-preventing membrane that is wrapped around the uterus.

Many women ask if a fibroid can be removed during pregnancy. Unfortunately, in most cases this is not advisable. First, the fibroid has a very active blood supply, which is increased during the pregnancy. Operations involving the uterus during the pregnancy can result in excessive bleeding, possibly requiring blood transfusion. So the surgery is usually delayed until after the pregnancy, when uterine operations are less likely to cause severe bleeding.

One more consideration: If you have a fibroid removed from deep within the uterine wall, your physician may advise that you have cesarean delivery for future pregnancies. The scar in the uterus where the fibroid was removed is believed to heal less strongly than the original uterine wall. So, if there are many large uterine scars, you may have an increased risk of uterine rupture at the scar site if you enter labor. I would suggest you speak to your physician after the surgery and ask whether cesarean section is advised for future deliveries.