The effect of fibroids on fertility.

19 June 2024

Amy

Understanding fibroids: common misconceptions, effects on fertility and pregnancy, and treatment options.

Fibroids, also known as uterine leiomyomas or myomas, are benign (non-cancerous) tumours that develop within the muscular wall of the uterus. They are a common gynaecological condition, particularly among women ages 30 to 50. While many women will not experience symptoms, fibroids can sometimes interfere with fertility.

What are fibroids?

Fibroids are solid growths of smooth muscle cells and fibrous connective tissue. They can vary significantly in size, from as small as a pea to as large as a melon. While the exact cause of fibroids remains unclear, factors such as genetics, hormones, and lifestyle play a role in their development.

Types of fibroids are classified based on their location within the uterus:

• Intramural fibroids: These develop within the uterine wall.
• Submucosal fibroids: These protrude into the uterine cavity.
• Subserosal fibroids: These extend to the outside of the uterus.
• Pedunculated fibroids: These are attached to the uterus by a thin stalk.

What are the symptoms of fibroids?

Fibroids can cause a variety of symptoms, although many women with fibroids may not experience any symptoms at all. The severity and nature of symptoms can vary depending on factors such as the size, number, and location of the fibroids.

Common symptoms of fibroids include:

• Heavy or prolonged menstruation
• Pelvic pain or pressure
• Lower back pain
• Pain during sex
• Frequent urination
• Infertility
• Abdominal swelling

Fibroid Misconceptions

Fibroids are incredibly common, affecting up to 70% of women by the age of 50. Despite their prevalence, there are many misconceptions about fibroids, particularly concerning their impact on fertility.

1. Fibroids are rare
   • Fibroids are quite common. Many women may have fibroids without even knowing it, as they can be asymptomatic. Regular gynaecological check-ups are helpful for early detection and management.
2. Fibroids are cancerous
   • Fibroids are benign tumours and rarely turn cancerous. The risk of a fibroid becoming cancerous (developing into leiomyosarcoma) is less than 1%.
3. Fibroids always cause symptoms
   • Not all women with fibroids experience symptoms. While some suffer from heavy menstrual bleeding, pelvic pain, and other symptoms, others might not even know they have fibroids.
4. Fibroids prevent pregnancy
   • While fibroids can pose challenges to fertility, many women with fibroids can and do get pregnant both naturally and through IVF treatment. The key is understanding the specific nature of the fibroids and working with healthcare providers to manage them effectively.
5. Hysterectomy is the only treatment
   • While hysterectomy (removal of the uterus) is one treatment option, it is usually reserved as a last resort and only when women have completed their families. Less major surgical options are available which can preserve fertility and uterine function.

Treatment options for fibroids

There are several treatment options for fibroids, ranging from medication to surgery. The choice of treatment depends on the severity of symptoms, size and location of fibroids, and the patient’s desire to preserve fertility.

1. Medications
   • Hormonal therapies
     • Medications like GnRH agonists can shrink fibroids by lowering oestrogen and progesterone levels. However, these hormonal therapies reduce the possibility of pregnancy and are not a long-term option.
   • Non-hormonal medications
     • NSAIDs can help manage the pain of fibroids and reduce heavy menstrual bleeding, but will not shrink fibroids.
2. Fibroid removal surgeries
   • Myomectomy
     • This surgery removes fibroids while preserving the uterus, providing a suitable option for women who wish to retain their fertility.
       • Laparoscopy: A minimally invasive surgery where fibroids are removed via small incisions in the abdomen and the uterus remains intact.
       • Open (Abdominal) Myomectomy: This is a more invasive procedure involving a larger abdominal incision to access and remove the fibroids from the uterus directly. This approach may be necessary for very large or numerous fibroids.
   • Hysterectomy
     • Removal of the uterus is considered when other treatments are ineffective or if the woman does not desire future pregnancies.

Can fibroids cause infertility?

While not all fibroids cause infertility, those that distort the uterine cavity or interfere with blood flow to the uterus can potentially decrease the chances of conception.

Large fibroids may distort the uterine cavity or block the fallopian tubes, making it difficult for sperm to fertilise an egg or for a fertilised egg to implant properly. Additionally, fibroids can affect the blood flow to the uterus, potentially compromising the development of a healthy embryo. 

Sometimes, fibroids cause pregnancy complications, depending on their size, number, and location. Large fibroids can increase the risk of miscarriage, preterm birth, and labour difficulties. 

While pregnancy with fibroids may pose challenges, fibroids do not necessarily prevent pregnancy altogether. With proper medical management and monitoring, women with fibroids can still conceive and have healthy pregnancies.

Can you get pregnant with fibroids?

Yes, pregnancy with fibroids is possible, although fibroids can affect fertility and pregnancy in various ways. Many women with fibroids conceive naturally or through IVF treatments and have successful pregnancies.

Many women with fibroids conceive and carry a pregnancy to term. Depending on the size, number, and location of the fibroids, treatment options such as myomectomy, a surgical procedure to remove fibroids, may be recommended to improve fertility outcomes. While fibroids can present fertility challenges, with proper management and medical care, many women can successfully conceive and become pregnant.

Managing fibroids during pregnancy requires individuals to work closely with their healthcare providers and careful monitoring to ensure the health and well-being of both the mother and the baby. By staying informed and proactive, women with fibroids can navigate pregnancy with confidence and support.

How do fibroids affect pregnancy?

Fibroids can impact pregnancy, but their effects may vary. For many women, pregnancy with fibroids is possible.

Fibroids can interfere with conception and pregnancy in several ways:

1. Blockage of fallopian tubes
   • Large fibroids can obstruct the fallopian tubes, preventing sperm from reaching the egg.
2. Altered uterine environment
   • Submucosal fibroids can distort the uterine cavity, making it difficult for a fertilised egg (an embryo) to implant.

Despite these potential challenges, many women with fibroids can conceive naturally or with the help of IVF treatments. While fibroids can affect pregnancy, many women with fibroids do become pregnant. It’s important to consult with a fertility specialist to understand the best approach for your unique situation.