TODAY, INDIANS are aware that fibroids are on the rise and are affecting around 25 million women in India. The Indian research, which Dr Prakash Trivedi has done, has revealed the cause for fibroids, which no one in the world knew before. This is a breakthrough research done for the first time in the world for which Trivedi recently was acknowledged by the national award. Trivedi’s research has been acknowledged in United States and Australia. Along with Dr Kumud Tamaskar, National Award winner for original research in infertility, he has released a book on ‘Infertility Dilemma’s Expert’s Final Verdict’ given to the Federation of Obstetrics and Gynaecology Society of India (FOGSI) as a publication for all gynaecologists.
The surgical techniques used for laparoscopic removal of fibroids is usually as follows: Trivedi’s laparoscopic technique of small five mm ports makes separation of fibroids of big size and multiple in number can be separated easily. With less bleeding, a dilute vasopressin is infiltrated as 20 units in 100 ml of saline to achieve a vascular plane. Most important is the fact that Trivedi’s endosuturing technique from same side, like in open surgery, is now being followed at more than 157 centres in the world making suturing safe and meticulous for next pregnancy.
The new promising research study suggests that incidence of fibroids can be increased in first degree female relative having fibroids, type of diet, excess weight, excess blood pressure etc. New unknown facts surfaced for the first time in world, found by an Indian gynaec endoscopist and In-vitro Fertility (IVF) consultant and showing a strong relation of fibroids contributing to infertility, especially by production of prolactin and aromatase locally leading to local hyper estrogenaemia. A strong relation was found between infertility in patients having fibroids more than five centimetres in size and more than three years of no conception. Apart from direct obstruction of tubal ostia, distortion of the tubo-ovarian anatomy and artificial of lengthening distance sperm has to travel to fertilise the oocytes.
Laparoscopic removal of fibroids increased the pregnancy rate to 42 per cent and decreased the abortion rate to five per cent without increasing the rate of uterine scar rupture on pregnancy, but increasing the need of doing elective caesarean section, especially due to removal of large and multiple myomas. In the IVF-ICSI group laparoscopic myomectomy of more than five centimetres in size prior increased the pregnancy rate to 38 per cent and specially, in the donor oocyte IVF to 50 per cent.
Also, the unnecessary feared uterine scar rupture after the laparoscopic myomectomy is disproved in the hands of experts. The future probably holds a promise in drugs, which are good aromatase inhibitors, which may further be extremely useful to reduce the size of the fibroid, arrest the growth and may even reduce a incidence of surgical removal of fibroids.
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