Uterine Fibroids and Fertility

Uterine fibroids and fertility facts

  • Fibroids are muscular tumors, rarely cancerous, that grow in the uterus and can affect fertility by disrupting the sperm and egg meeting for fertilization or embryo implantation.
  • Also called leiomyomas or myomas, these tumors often develop during a woman’s childbearing years and can range in size from tiny seeds to masses as large as basketballs.
  • Uterine fibroids are common, with up to 80% of women having them during their lifetime, though most women experience no symptoms and may never know they have fibroids.
  • Women who do have fibroid symptoms may suffer varying levels of pain, menstrual bleeding and pelvic pressure, depending on the size, location and number of fibroids.
  • Aside from their effect on infertility, another concern with having fibroids is possible complications during labor and delivery, and women with fibroids are six times more likely to have a C-section.
  • Treatment, either medications or surgery, greatly depends upon symptoms and whether a woman would like to preserve her fertility.
  • It’s important to discuss possible fibroids with a doctor and get a specific diagnosis, especially if trying to conceive.

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What are uterine fibroids (leiomyomas)?

Fibroids are dense, muscular tumors that grow in or around the walls of a woman’s uterus, and sometimes in the cervix. Many women, about 20% to 80%, will develop a fibroid by the age of 50.

Fibroid tumors are almost always noncancerous, or benign. Some uterine fibroids do begin as cancerous tumors but that is rare (less than 1 in 1,000). A benign fibroid can’t become cancerous.

Fibroids range in size from as small as a sunflower seed or as large as a basketball. These uterine tumors grow at different rates in women, and can be different sizes in a woman who has more than one.

They are generally classified by where they develop. Research shows the type has a bearing on success of assisted reproductive technologies (ART) such as in vitro fertilization (IVF).

Types of fibroids

Intramural fibroids

These grow within the muscular uterine wall and can sometimes stretch the uterus. Intramural are the most common type of uterine fibroid, and appear to have some effect on ART success

Submucosal fibroids

These develop in the middle muscle layer and bulge into the uterine cavity. These are the least common type, but they can have the most significant effect on success rates of ART.

Subserosal fibroids

These form on the outside of the uterus (the serosa), and have a negligible effect on ART. These can grow to be large and affect the shape of the uterus. They can also grow on a stalk attached to the outside of the uterus, and are then known as pedunculated fibroids.

Can fibroids cause infertility?

Depending on their location and severity, fibroids can have an effect on fertility. For example, fibroids may:

  • Alter the shape of the uterus and cervix, impeding the movement of sperm to the egg for fertilization.
  • Grow to block the fallopian tubes, preventing a fertilized embryo from reaching the uterus.
  • Affect blood flow to the uterine cavity, decreasing the ability of an embryo to implant and contributing to pregnancy loss.

That said, most women who have fibroids can conceive naturally and without issue. When the fibrous tumor does cause infertility, there are treatments that can reverse it.

Cause of fibroids and risk factors

While the causes of the growths are undetermined, research suggests genetic and hormonal components at work. The hormones estrogen and progesterone, for example, appear to promote uterine fibroid growths (and may be why they occur during childbearing years and sometimes develop during pregnancy).

The following factors can increase a woman’s likelihood of developing them.

  • Age: Growths are more likely to develop during a woman’s childbearing years and typically shrink after menopause.
  • Family history: It is not uncommon for mothers, daughters and sisters to all experience leiomyomas.
  • Ethnicity: Studies show Black women are more likely to develop fibroids and may experience stronger symptoms than white women.
  • Diet: Women who are overweight are at 2-3 times higher risk for fibroids. There is also a link to an increased risk for those who are heavy drinkers or who eat a lot of red meat and ham.

Fibroid symptoms and diagnosis

Most women do not experience symptoms and often only learn of their existence during a routine pelvic exam or ultrasound.

In women who do have symptoms, the most common signs of leiomyomas include:

  • Heavy and prolonged menstrual bleeding.
  • Anemia.
  • Pelvic pressure or pain.
  • Frequent urination.
  • Difficulty emptying the bladder.
  • Bloating and constipation.
  • Backache or leg pains.
  • Painful intercourse.
  • Reproductive problems including miscarriage and infertility.

Diagnosing fibroids

A routine pelvic ultrasound often detects the first signs of these growths. From that point, our fertility specialists may try additional tests to verify the exam findings and to find out more about the fibroid, including type, size, number and exact location. Additional imaging tests such as an MRI may also be required but only rarely.

The primary diagnostic tests for leiomyomas are:

  • Ultrasound in which sound waves return an image of the abdomen.
  • Laparoscopy involves a small incision and a laparoscope that gives the surgeon a view inside the abdomen.
  • Hysteroscopy, which is a similar viewing procedure, with the hysteroscope inserted through the vagina into the uterus.
  • Hysterosalpingoram, which is a type of X-ray test.
  • Sonohysterogram, or saline infusion sonogram, inserts fluid into the uterus to provide a clearer picture from ultrasound.

Common questions about fibroids

  • When should I see a doctor? If you have fibroid symptoms, consult your doctor if you experience a shift in them or are having difficulty getting pregnant.
  • How do I know if I have fibroids? A fertility specialist can help assess if fibroids are hampering conception by performing a physical exam and an ultrasound to determine their size, number and location.
  • Can fibroids affect a pregnancy? It’s a good idea to keep an eye on fibroids during pregnancy because they may grow larger or create complications, such as needing a C-section (women with fibroids are six times more likely to have a C-section).
  • Can fibroids cause cancer? A benign fibroid can’t become cancerous. A uterine fibroid can begin as a cancerous one, though it is extremely rare and less than 1 in 1,000 fibroids begin as cancerous.

Treatment for fibroids

Treatment is decided on a case-by-case basis. This is dependent upon several factors, such as a woman’s age, potential pregnancy plans, as well as the size, location and impact of fibroid symptoms like heavy or painful periods, pelvic pain and bleeding between periods.

Most women who have no symptoms may not even need treatment. For those with mild discomfort, medication is commonly recommended. For example, over-the-counter drugs can stave off mild pain.

Low-dose birth control can decrease heavy bleeding and painful periods. Gonadotropin-releasing hormone agonists stop periods and shrink the growths. Intrauterine devices that release progesterone are helpful for symptom relief in some women.

For those suffering more severe symptoms, surgery is the most common form of treatment. A myomectomy removes the fibroids and can allow the woman to have children afterward. A hysterectomy removes the uterus. Because the entire uterus is removed in a hysterectomy, there is no possibility of a future pregnancy using one’s own uterus. Some fibroids can also be removed during a hysteroscopy, a surgery using a camera and tools through the vagina.

More novel minimally-invasive treatments include a uterine artery embolization procedure, which injects small particles into fibroid blood vessels, starving the fibroids and causing them to shrink and die. Focused ultrasound treatment (using an MRI) may also shrink a fibroid, but not remove it entirely.

Treatment risk

Risks due to treatment also vary upon the method performed. Surgery always carries a risk of blood loss, pain and infection. Medications and anesthesia may also cause allergic reactions. Lastly, some procedures may reduce or remove a woman’s ability to get pregnant.

It’s important for women to discuss all treatment options, their benefits, their risks and their family plans with a doctor before undergoing any procedure.