Fibroids and fertility: Can fibroids affect your ability to get pregnant?

Understanding and managing fibroids for your fertility

Fibroids, or uterine leiomyomas, are one of the most common gynecological conditions, yet their impact on fertility is often misunderstood. By age 50, up to 70–80% of women will develop fibroids, though many remain asymptomatic and unaware of their presence. However, for women on a fertility journey, fibroids can pose unique challenges. This guide aims to provide a comprehensive understanding of fibroids, their implications on fertility, and the available management options.

What Are Fibroids?

Fibroids are benign tumors that develop from the muscular wall of the uterus. They arise in the smooth muscle tissue of the uterus and are classified as tumors, but the vast majority are non-cancerous. While the term “tumor” might sound alarming, the likelihood of malignancy is extremely low. A rare subtype, known as leiomyosarcoma, represents less than 1% of fibroids.

Fibroids vary widely in size, ranging from a few millimeters to sizes larger than a watermelon. The largest recorded fibroid weighed 140 pounds and was removed from a woman in Singapore in 2014. Most fibroids, however, are much smaller and do not cause symptoms unless their size or location disrupts normal uterine function.

What Causes Fibroids?

The precise cause of fibroids remains unclear. However, several factors contribute to their development:

1. Hormonal Factors: Fibroids are highly sensitive to hormones, particularly estrogen and progesterone. They tend to grow during a woman’s reproductive years when hormone levels are high and often shrink after menopause when hormone levels decline.
   
2. Genetic Predisposition: A family history of fibroids significantly increases the likelihood of developing them.
   
3. Age: The risk of developing fibroids increases with age, especially in women in their 40s.
   
4. Other Potential Factors: Inflammation, lifestyle, and environmental factors are being studied for their potential roles in fibroid development. Despite ongoing research, the exact mechanisms remain elusive.
   

Symptoms of Fibroids

Fibroids are often asymptomatic, particularly in women undergoing fertility evaluations. However, symptomatic fibroids can cause a wide range of issues, including:

• Heavy or Prolonged Menstrual Bleeding: Symptoms include requiring double protection (pad and tampon), changing menstrual products frequently (e.g., every two hours), and experiencing anemia due to excessive blood loss.
  
• Pelvic Pain and Pressure: Larger fibroids may press on surrounding organs, causing pelvic discomfort, back pain, or shooting pain down the legs.
  
• Bladder and Bowel Symptoms: Depending on their size and location, fibroids may cause frequent urination, difficulty emptying the bladder, or constipation.
  
• Infertility or Recurrent Pregnancy Loss: Fibroids can interfere with conception and implantation, as well as cause miscarriage in some cases.
  

Fibroids and Fertility: Types of Fibroids

Fibroids are classified by their location in the uterus, which largely determines their impact on fertility:

1. Submucosal Fibroids: These grow inside the uterine cavity, where embryos implant. Submucosal fibroids are most likely to affect fertility by distorting the uterine cavity or blocking the fallopian tubes. They are associated with significantly reduced pregnancy rates.
   
2. Intramural Fibroids: Found within the uterine wall, intramural fibroids can distort the uterine cavity if they grow large enough. While their impact on fertility is less clear, studies suggest that fibroids close to the uterine lining or larger fibroids can reduce pregnancy rates.
   
3. Subserosal Fibroids: Located on the outer surface of the uterus, subserosal fibroids typically do not affect fertility unless their size or location interferes with the fallopian tubes or other structures.
   
4. Pedunculated Fibroids: These fibroids are attached to the uterus by a thin stalk. While rare, their size or movement can cause pregnancy-related complications.
   

Diagnosing Fibroids

Fibroids are most commonly diagnosed through imaging:

• Pelvic Ultrasound: This is the standard diagnostic tool and can identify fibroids of various sizes and locations.
  
• Sonohysterogram (also known as SONO): This specialized ultrasound evaluates the uterine cavity, helping to determine if fibroids are distorting the endometrium.
  
• MRI: Used in complex cases, MRI provides detailed imaging of fibroids and their relationships with surrounding structures.
  

In many fertility patients, fibroids are discovered incidentally during routine assessments, as they are often asymptomatic.

The Role of Fibroids in Infertility

Fibroids can affect fertility in several ways, depending on their type, size, and location. Studies have consistently shown the importance of these factors.

A nuanced evaluation of each fibroid’s characteristics is essential when determining its potential impact on fertility.

Treatment and Management of Fibroids

The management of fibroids depends on their size, number, location, symptoms, and a woman’s reproductive goals.

Medical Management:

• Hormonal Therapy: Medications like GnRH agonists can shrink fibroids temporarily but are generally used for short durations due to limited efficacy and potential side effects.

Non-Surgical Options:

• Uterine Fibroid Embolization (UFE): This minimally invasive procedure blocks blood flow to fibroids, causing them to shrink. However, it is NOT ideal for women planning future pregnancies, as it can impact uterine blood supply.

Surgical Treatments:

1. Hysteroscopic Myomectomy: Best for submucosal fibroids, this minimally invasive procedure removes fibroids through the cervix without abdominal incisions.
   
2. Laparoscopic Myomectomy: Suitable for smaller intramural or subserosal fibroids, this procedure involves tiny abdominal incisions and offers quicker recovery.
   
3. Laparotomy (Open Myomectomy): Used for larger or complex fibroids, this more invasive surgery requires a longer recovery period.
   

Post-surgery, patients may be advised to wait several months before attempting conception to ensure proper healing.

Fibroids During Pregnancy

Fibroids can coexist with pregnancy, often without complications. However, some scenarios warrant attention:

1. Breech Presentation or Obstruction: Large fibroids may prevent the baby from turning or block the birth canal, necessitating a cesarean delivery.
   
2. Pain from Fibroid Degeneration: During pregnancy, fibroids may outgrow their blood supply and become necrotic, causing severe pain and inflammation.
   
3. Impact on Delivery: Depending on their size and location, fibroids can complicate labor and delivery, requiring careful planning and monitoring.
   

Surgery Risks and Considerations

While surgical removal of fibroids might seem like an obvious choice, it is not without risks. Surgery can lead to:

• Uterine Scarring: Known as Asherman’s syndrome, scarring can impact implantation and increase the risk of complications.
  
• Weakened Uterine Wall: Post-surgery, the uterus may be at higher risk of rupture during pregnancy or labor.
  
• Recovery Delays: For women with limited reproductive time, the recovery period following surgery might be a crucial consideration.
  

Fertility Preservation Options

For women whose fibroids interfere with fertility but who wish to avoid surgery immediately, options include:

• IVF with Embryo Freezing: Fertilizing and freezing embryos allows women to preserve fertility while addressing fibroids later.

This approach prevents delays caused by surgery and recovery, particularly when the fertility clock is ticking.

Do you name your fibroid(s)?

Fibroids often become a part of a patient’s fertility journey, and some women even name their fibroids to personalize their experience. One patient nicknamed her fibroid and her baby growing alongside it, turning a challenging situation into a unique and empowering story.

Conclusion: Navigating the Complexities of Fibroids and Fertility

Managing fibroids in the context of fertility is a complex, individualized process. While fibroids can present challenges, many women achieve their fertility goals with proper treatment and care. Open communication with a fertility specialist is key to understanding risks, benefits, and tailored treatment options.

And for a touch of humor:
Why did the fibroid get invited to all the parties?
Because it really knew how to grow on people!

Share your experiences or questions with us on Instagram @myfertilitypodcast!