Fibroids and Fertility

Key Takeaways

• Uterine fibroids are noncancerous growths in the uterus made of muscle tissue. These growths can vary dramatically in size, with some remaining too small to see with the naked eye and others growing so large they change the shape of the abdomen.

• Fibroids may cause complications that require treatment options ranging from surgery to hormone therapy and ultrasound therapy, however fibroids do not always require medical intervention.
• Most women with fibroids are still able to conceive, but it’s essential to evaluate thoroughly if fertility issues arise. 

What Are Fibroids?

Uterine fibroids (also known as myomas or leiomyomas) are benign, non-cancerous growths that develop in the muscle wall of your uterus. They can vary in size, from tiny seeds to grapefruit-sized masses, and they can grow individually or in clusters. 

Uterine fibroids are relatively common, affecting a significant portion of women. According to the American Society for Reproductive Medicine, approximately 80% of African American women and 70% of Caucasian women will experience fibroids by the time they reach menopause. 

While these growths often become noticeable during the reproductive years, they tend to shrink after menopause. In most cases, fibroids remain asymptomatic and do not require medical intervention. However, their size and location within the uterus usually determine the symptoms that arise, requiring treatment in some instances.

Causes of Fibroids

Fibroids are created when a cell in the wall of the uterus becomes genetically altered, producing extra muscle tissue. This muscle tissue builds up and forms a lump. Scientists don't know exactly why this happens, but it’s believed that both genes and hormones might be involved, leading to the uncontrolled expansion of abnormal tissues.

Johns Hopkins University suggests there are certain risk factors associated with the development of fibroids, with some related to genetics and others related to lifestyle factors. Generally speaking, women who are of reproductive age are more at risk of developing fibroids than prepubescent individuals or those who have gone through menopause. Additional risk factors include:

• A family history of fibroids
• Obesity
• A diet high in red meat
• High blood pressure

Johns Hopkins also notes that black women experience a higher rate of fibroid development and more often require treatment than other women.

Signs of Fibroids

As mentioned above, many women with fibroids experience no symptoms at all. However, some common symptoms include: 

• Heavy or prolonged periods
• Painful periods
• Pain during sex
• Frequent urination
• Bloating or pressure in the lower abdomen
• Back pain

The treatment approach for fibroids depends on the symptom severity and your doctor’s advice. Most fibroids do not require treatment, and in many cases they go undetected for years without causing any issues. In instances where pain, bleeding, or other concerning symptoms present themselves, medical intervention may be necessary.

How Are Fibroids Treated

Fibroids can be addressed either surgically or with prescription medication.

Surgery

There are a variety of options for removing fibroids surgically, depending on the size of the growths and the health, age, and future family planning of the patient.

Hysteroscopic Myomectomy 

For small, problematic fibroids, a procedure known as a hysteroscopic myomectomy can be performed during a one-day outpatient process. During this procedure, a hysteroscope, or small camera, is inserted into the uterus through the cervix to locate the fibroids. A small surgical instrument is then inserted to cut or burn away the growth. However, only fibroids that are visible from the inside of the uterus and are not above a certain size are amenable to hysteroscopic myomectomy.  

Laparoscopic Myomectomy

Larger fibroids can be removed in a similar fashion but using small incisions made in the lower abdomen in a process called laparoscopic myomectomy. The general process is the same for these types of procedures, but the use of abdominal incisions allows for the removal of larger fibroids than a hysteroscopic procedure. This type of surgery is also typically a one-day outpatient procedure.

Abdominal Myomectomy

Very large fibroids or fibroids in difficult locations may require a large abdominal incision, similar to that of a c-section. These are larger surgeries that often require hospital admission prior to discharge home. 

Hysterectomy 

For those not planning to have children in the future, or when recurring fibroids have majorly impacted a patient’s quality of life, a full hysterectomy is also an option. In this procedure, the full uterus is removed, therefore stopping fibroid growth but also preventing future pregnancy and menstruation from occurring. This process is done under some form of sedation, either general or local anesthesia, to keep the patient as comfortable as possible. 

Nonsurgical Options

Recent medical advances have uncovered a variety of treatments for fibroids that do not require surgery, especially for milder symptoms or symptoms caused by smaller fibroids.

Several hormone treatments have shown promising results in shrinking fibroids or alleviating their symptoms, particularly with medications that fall under a classification known as gonadotropin-releasing hormone agonists (GnRHa). These medications reduce the levels of estrogen in the body, which can slow and even reverse the growth of uterine tumors like fibroids.

GnRHa treatments are intended for short-term use only, though, as long-term use can have serious undesirable side effects. This form of hormone treatment is most commonly used ahead of surgical treatment to increase its likelihood of success.

Other medicine-based treatments focus on addressing fibroid symptoms, and one of the most common forms of treatment is the prescription of oral contraceptive pills. Birth control pills have been shown to reduce the excessive bleeding caused by many problematic fibroids by reducing the size of the endometrium.

In addition to medication-based options, new procedures have been developed which show promising results in treating fibroids without surgery. Uterine fibroid embolization is a procedure by which a small catheter is inserted close to the fibroid and used to block blood flow to the fibroid, damaging the growth and causing it to shrink by as much as 50 percent. There is, however, some concern that this procedure could also damage normal parts of the uterus that may negatively impact future pregnancies. 

There are also ultrasound-based treatments available for fibroids which use focused, high-energy sound waves to destroy fibroids without harming the surrounding tissue. These treatments have been shown to eradicate fibroids in certain cases. However, there is no long-term research at this time showing how it might impact fertility for those who undergo this type of procedure.

Fibroids and Fertility

While not all women with fibroids experience fertility issues, they can significantly impact your ability to conceive. Uterine fibroids can impact fertility in several ways:

• Cervix Shape ChangesFibroids can alter the cervix’s shape, affecting the number of sperm that can enter the uterus.
• Blocked Fallopian TubesSome fibroids may block the fallopian tubes, hindering egg transportation for fertilization.
• Uterine Lining SizeFibroids might affect the size and shape of the uterine lining, influencing embryo implantation.
• Reduced Blood FlowDecreased blood flow to the uterine cavity can make it harder for embryos to stick to the uterine wall or develop.

Fibroids can also negatively impact In Vitro Fertilization (IVF) success rates. The location of the fibroids plays a significant role, with submucosal fibroids (protruding into the uterine cavity) and intramural fibroids (within the uterine muscle) posing greater challenges to fertility than others. 

Fibroids and Pregnancy

A 2010 study found that while most pregnancies with fibroids go smoothly, there is evidence that they can increase the chances of some complications, including:

• Miscarriage  
• Premature birth  
• Placenta abruption (when the placenta detaches from the uterus before birth)  
• Baby in an unusual position  
• Difficult labor  
• Cesarean section  
• Bleeding after childbirth

Most fibroids stay the same size during pregnancy, however about one-third might grow slightly in the first few months.  

It's important to remember that these complications are not common for everyone with fibroids, and many women have healthy pregnancies despite having them. However, if you are pregnant or trying to become pregnant and have fibroids, it’s important to talk to your fertility care expert about potential risks.  

When Should I See a Doctor?

Most women with fibroids won’t experience infertility, but a thorough evaluation is essential if fertility issues arise.If you're navigating the complexities of fertility and have questions about fibroids, our expert team at San Diego Fertility Center is here to support you with personalized guidance and compassionate care. Contact us today to schedule your appointment.  

The information provided in this article is for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.