Reply: Intramural fibroids

Sirs, We thank Dr Nawroth for his comment. Uterine fibroid are classified as being submucosal (beneath the endometrium), intramural (centered in the muscular wall of the uterus) or subserosal (beneath the uterine serosa). Therefore, in our laboratory, in case of a fibroid which has myometrium layer between endometrium and fibroid, this fibroid is categorized as intramural type. The presence of myometrium layer can be observed with magnetic resonance imaging test. We found that the large size of intramural fibroid can deform the uterine cavity even in the presence of myometrium layer between them. Submucosal type fibroid which is located beneath the endometrium can cause deformed uterine cavity. But we believe that the opposite is not always true, that is to say, deformed uterine cavity is not always caused by submucosal type, but large intramural type. Donnez and Jadoul (2002) reviewed articles and concluded that submucosal and intramural myomas distorting the uterine cavity impair implantation and pregnancy rates in women, admitting that both submucosal and intramural myomas distort the uterine cavity. We believe that the concept that some intramural fibroids can cause deformation of uterine cavity has been accepted.