I've heard of a new treatment for fibroid tumors that uses video-guided laparoscopic surgery. A drug is injected into the fibroid, cutting off its blood supply. The surgery leaves the uterus intact so the woman is able to conceive, and it's supposed to cut down on menstrual complaints. What is this treatment called, and is it generally available? --Twyla

There are a few new techniques for managing fibroids (myomas). At present, I do not believe they are appropriate for those who plan to attempt pregnancy.

The first is called myolysis. First you are placed on a GnRH-agonist such as Lupron or Zoladex for a period of up to three months to shrink the myoma. If the myoma shrinks significantly, we can schedule an outpatient laparoscopy. During the surgery, I will place a needle through the wall of the uterus below the myoma to coagulate its blood supply. This is repeated around the periphery of the tumor. My concern is that by coagulating the blood supply, I might not only weaken the wall of the uterus, but I may also adversely affect the blood supply to a future pregnancy. This could have disastrous consequences.

A second new procedure is called myoma embolization. During this procedure, a catheter is inserted into the blood vessels of the leg and guided into the uterine artery. A material that promotes blood clotting is injected through the catheter into the uterus to cut off the blood supply to the fibroid, which causes it to shrink. I am not aware of studies that evaluate the safety and effectiveness of this technique when performed before pregnancy.

My advice to you is to check with a skilled reproductive endocrinologist to determine the likelihood that the myoma will interfere with pregnancy or result in infertility. If so, surgery is the best approach. In my opinion, if the myoma deeply invades the wall of the uterus, a laparotomy (open-belly surgery) ensures the best repair and results in least risk for a subsequent pregnancy.