Fibroids and Fertility

Several factors can impact how quickly and easily you get pregnant and even carry the baby to term. If this is the case, you are not alone. Many people, both male and female, struggle with infertility. In women, a number of conditions can affect a woman’s reproductive system and, in turn, their fertility, including uterine fibroids. Let’s take a look at what fibroids are, how they form, and how they can affect fertility.

Key Takeaways

• Fibroids are common, non-cancerous growths of muscle that form in the uterus.
• These growths can vary dramatically in size
• Most women with fibroids have normal fertility and pregnancy outcomes
• Fibroids occur in up to 70% of women by the time they are 50 years old.
• Fibroids don’t always show symptoms or need treatment.

What Are Fibroids?

Uterine fibroids, also called uterine myomas, are non-cancerous tumors that grow in or on the uterus and tend to appear during childbearing years. They range in size where they are undetectable or can grow into large masses. Some women have a single fibroid, while others present with multiple ones. 

The location of the fibroid also matters. They can directly attach to the uterine wall or be connected to the uterus by a stalk. They can also be attached to ligaments or organs around the uterus. Fibroids affect around 20% to 80% of women by the age of 50. 

While in most cases, they have no signs or symptoms, fibroids can cause severe stomach pain and heavy periods. 

Types of Uterine Fibroids

There are four main types of fibroids, categorized based on where they are located and how they attach themselves.

• Intramural fibroids. These are the most common fibroids and develop inside the muscular wall of your uterus. In extreme cases, they can expand and stretch your uterus.
• Subserosal fibroids. This type of fibroid comes from the exterior of the uterus (serosa) and can grow large enough, making one side of your uterus appear bigger than the other. They can also grow into the pelvis and can grow really large.  
• Submucosal fibroids. These fibroids are quite rare. They form in the myometrium, the uterus’s middle muscular layer.
• Pedunculated fibroids: These fibroids attach to the wall of the uterus with a stem, making them look like mushrooms.  They attach to the outside of the uterus and can extend to other areas. 
• Cervical fibroids. The cervix is found at the opening of the uterus, right at the top of the vagina. Cervical fibroids form on the cervix but are also rare. 

Though they can be harmless, some fibroids can lead to medical complications with the potential for serious side effects. 

What Causes Fibroids?

The cause of fibroids is largely unknown. However, according to Johns Hopkins University, fibroids develop from abnormal muscle cells in the uterus that multiply rapidly when they are affected by estrogen hormone. Some research has also shown that genetics, negative lifestyle choices, and obesity can be risk factors. 

Symptoms of Fibroids

Many women live without knowing they have fibroids. However, some women do show symptoms like:

• Heavy and painful periods
• Pain during intercourse
• Bleeding in-between periods
• Longer periods
• Anemia
• Frequent urination or difficulty emptying the bladder
• Constipation 
• Shorter menstrual cycles
• Lower back pain
• Infertility 
• Complications during pregnancy

Many patients with fibroids still go on and have safe and healthy pregnancies. Nevertheless, some fibroids grow during pregnancy, leading to a higher risk of premature delivery or pregnancy loss. Your doctor will be able to monitor and manage your fibroid symptoms to help reduce the risk of complications for you and your baby.

How Are Fibroids Treated

Since they may be too small to even be detected, most fibroids do not require any treatment. When symptoms show, it may be time to seek medical support. Your treatment options depend on the location, size, and type of fibroid you have. 

According to a 2010 study, when fibroids go untreated fibroids they can result in: 

• Fallopian tube blockage
• Spontaneous miscarriage
• Preterm labor
• Placenta abruption
• Malpresentation
• Labor dystocia
• Increased chances of cesarean delivery
• Postpartum hemorrhage

Medication

Fibroids can be maintained successfully with medication. Some medications given include:

• Contraceptives: Studies have shown that contraception has an impact on uterine fibroids. 
• Iron supplements: Iron supplements are given to those who bleed heavily because of the fibroids. They help to prevent or correct anemia.
• Gonadotropin-releasing hormone agonists (GnRHa): GnRHa drugs are given to patients to shrink the fibroids. They come in the form of nasal sprays and injections. 

Surgery

Surgery is an option used when the fibroid needs to be removed. There are different types of surgeries done on fibroids. 

Hysteroscopic Myomectomy

This is a surgical procedure done using a hysteroscope, or small camera, that’s inserted into the uterus through the cervix and used to locate the fibroids. A small surgical instrument is then inserted for cutting or burning the fibroid. It mainly targets small problematic fibroids. This procedure removes the fibroids but leaves the uterus intact. 

However, a myomectomy can affect the muscular layer of the uterus depending on the location of the fibroid. This may raise the risk of uterine rupture during pregnancy. Following a myomectomy, some doctors recommend a C-section as a birth plan. 

Radiofrequency Ablation (RFA)

RFA is an invasive procedure where heat generated by radiofrequency energy is used to eliminate the fibroids. Small incisions are made in the abdomen, vagina, or cervix, and specialized needles are then used to heat and destroy the fibroid tissue. This treatment preserves the uterus and can be done as an outpatient procedure. It also has a relatively quick recovery time. 

Full Hysterectomy

This procedure is for those who don’t intend to have children or who have recurring fibroids. Here, the entire uterus is removed, preventing future uterine fibroids and pregnancies.

Uterine Fibroid Embolization

Medical interventions have evolved, resulting in better options like uterine fibroid embolization. UFE is a minimally invasive medical procedure where a small catheter is inserted close to the fibroid, and tiny particles (embolic agents) are injected that block blood flow to the fibroid. This not only shrinks up the fibroid to almost half its size but also ensures the fibroid doesn’t continue to grow. This non-surgical option has a shorter recovery time compared to surgery.

How do Fibroids Affect Fertility?

Some types of fibroids can have a negative impact on your fertility. For example, fibroids that bulge at the center of the uterus can make it more difficult for an embryo to implant into the lining of the uterus. For some women, removing fibroids with uterus-sparing treatments may improve fertility. In severe cases, only surgical interventions can treat the fibroids, and this can cause scarring, which can affect fertility.

If you have fibroids and are having trouble getting pregnant, the compassionate healthcare providers at Ivy Fertility will be able to rule out any other causes of infertility and offer assisted reproductive treatment options should you still desire to conceive. 

Bottom line

Uterine fibroids are common and can affect fertility in many ways. They can affect whether sperm and egg meet, whether an embryo can implant in the uterus, whether a pregnancy can continue and can also affect the growth and positioning of the baby. Nevertheless, many people with fibroids rarely experience any complications, and even more so when trying to conceive and go on to conceive naturally and carry a pregnancy to birth.