Fibroids and Their Impact on Fertility and Pregnancy
Many women ask us, can fibroids cause infertility? The relationship between fibroids and fertility is complicated because having fibroids does not automatically mean fertility issues will occur, but they can create significant challenges for women trying to conceive and carry a pregnancy to term. The impact on how they influence your reproductive system depends on their size, location, and the number of fibroids present.
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An Overview of Fibroids and Fertility
Uterine fibroids are non-cancerous growths that develop in or on the uterus. These benign, hormone-dependent tumors develop in the myometrium, the muscular layer of the uterus, and increase in size under the influence of the female sex hormone estrogen.
Nearly 80% of women develop fibroids before age 50, though many remain unaware because they experience no visible symptoms. Women in their childbearing years represent 30% of those affected by fibroids, making the connection between fibroids and pregnancy or reproductive health particularly significant.
Prevalence and Demographics of Affected Women
Uterine fibroids occur in approximately every third woman, primarily after age 30. However, the condition is becoming increasingly prevalent in women under 30 years of age. Women of color are at increased risk and are more likely to develop fibroids at an earlier age. This problem is becoming increasingly relevant in connection with late pregnancy planning (after 40 years old), when the risk of uterine fibroids, endometriosis, and inflammatory diseases is significantly increased.
According to CDC data, one in five women between the ages of 15 and 49 have issues becoming pregnant after trying for a year. Additionally, a quarter of the women in this age group either have trouble conceiving or sustaining a pregnancy. This means over 25% of women in their childbearing years face challenges trying to have a baby.
Fibroid Types and Locations
Fibroids are named by their location and how they grow. Understanding these types is essential because location plays a critical role in determining their impact on fertility and pregnancy.
- Submucosal fibroids grow within the open space (cavity) or just underneath the lining of the uterus. These fibroids pose the greatest threat to fertility. Large submucosal fibroids can decrease a woman’s fertility rate by up to 70%. They can alter the structure of the uterine cavity, similar to the effect of an intrauterine device (IUD), prevent pregnancy from occurring, and distort the uterus so much that the embryo cannot implant securely.
- Intramural fibroids grow within the muscle wall of the uterus and can change its shape or protrude into the uterine cavity. Even when not large, they may prevent pregnancy, cause miscarriage, or lead to major complications during pregnancy. Numerous or large intramural fibroids can block sperm or eggs or interfere with successful implantation.
- Subserosal fibroids grow on the outer surface of the uterus or extend outward into the pelvis. These fibroids generally have less impact on fertility compared to submucosal and intramural types.
- Pedunculated fibroids grow on stalks attached to the uterus. Their effect on fertility depends on their size and exact location.
Diagnosing Fibroids During Pregnancy
Some women know they have fibroids before they become pregnant and may or may not have sought previous treatment. Others may not even realize they have fibroids because they have never experienced any symptoms. After becoming pregnant, these women may start having issues because the fibroids are growing larger due to the increase in their estrogen levels. This often prompts them to seek help from their doctor, who will normally perform an ultrasound as the first diagnostic test for fibroids.
Depending on the circumstances, the doctor might be able to see the fibroids on the ultrasound, but it is often difficult to determine exactly how many fibroids are present, how large they are, or precisely where they are located due to the low quality of the image.
Accurate imaging for fibroid detection is best achieved with MRI. An MRI is considered safe for most pregnant women and provides a much more detailed view of the fibroids. It has significantly higher resolution and can more accurately determine the size and number of fibroids, which allows the doctor to better assess the likelihood of the fibroids becoming a serious issue while trying to conceive or during a pregnancy.
Freedom From Fibroids Without Surgery
At Atlanta Fibroid Center®, we specialize in fibroid treatment and provide a non-surgical, minimally invasive procedure called uterine fibroid embolization (UFE). After this 45-minute procedure, all fibroids shrink and stop causing debilitating symptoms.
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How Can Fibroids Affect Conception?
Fibroids can affect a woman’s ability to become pregnant in several ways, including:
- Uterine and Cervical Distortion Fibroids can change the shape of the uterus and cervix, which reduces the quantity of sperm entering the uterus and the chances of fertilization. They interfere with the movement of the sperm and embryo, leading to reduced fertility.
- Fallopian Tube Blockage Large submucosal fibroids may put enough pressure on the fallopian tube to seal it off, preventing sperm from reaching the egg or stopping a fertilized egg from traveling safely into the uterus to implant. Fibroids can block the fallopian tubes, creating barriers to the movement of both sperm and eggs.
- Implantation Interference Submucosal and intramural fibroids can prevent pregnancy by distorting the shape of the uterus so that the embryo is unable to implant and become viable. If an embryo attempts to implant on top of a fibroid, it may not receive enough nutrients to grow and thrive.
- Blood Flow Disruption Fibroids can alter blood flow to the uterine lining and damage the environment needed to sustain a healthy pregnancy. Because fibroids require a blood supply to grow, they can divert blood flow away from a developing baby.
- Weakened Uterine Wall Fibroids can weaken the uterine wall, making it more difficult to conceive or safely carry a pregnancy to full term.
Factors Affecting Conception with Fibroids
- Physical barriers to conception: Women who have fibroids can experience heavy and prolonged bleeding and discomfort from period-related symptoms. Fibroids can also make sexual intercourse painful or cause feelings of uncomfortable pressure, which can make trying to conceive naturally difficult.
- Emotional and psychological impact: The discomfort and symptoms caused by fibroids can also cause irritability and depression, decreasing a woman’s sex drive and reducing her desire for sexual intimacy and the frequency of intercourse. Abdominal bloating, weight changes, or heavy bleeding can cause embarrassment, shame, or a negative body image and reduce sexual confidence, which can lead to fewer opportunities to conceive.
How Often Do Fibroids Affect Fertility?
Can fibroids prevent pregnancy? Yes, in some cases, uterine fibroids can prevent a woman from becoming pregnant or from experiencing a successful pregnancy. Around 10% of women struggling with infertility have fibroids, and research shows that for approximately 2% to 3% of these women, fibroids are the only reason they are experiencing fertility issues.
A study published in 2021 reported that women with fibroids had substantially fewer instances of implantation, pregnancy, and live birth than those without fibroids. The study also found that women with fibroids had a significantly higher rate of miscarriage.
Fibroids can disrupt implantation of the fertilized egg and embryo development, which then leads to infertility or pregnancy complications. In other cases, fibroids can exacerbate other underlying conditions.
Large Fibroids and Pregnancy
Most experts agree that fibroids reaching around 5 centimeters in diameter (a little smaller than 2 inches) should be removed from the uterus for women wishing to preserve their fertility. One thing that is noteworthy is that the size of the fibroid is not the only thing that can impact fertility, and it is more about the location that determines how much of an impact it will have on pregnancy and conception.
Large fibroids can prevent conception or a viable pregnancy, but clusters of smaller fibroids can also create significant issues. They can cause the uterus to become misshapen, create inflammation, create irregular blood vessel patterns, or create unwanted uterine contractions that can result in complications like preterm labor or spontaneous abortion.
Challenges Caused by Fibroids During Pregnancy
First Trimester Growth and Complications
One significant fact researchers have uncovered is that uterine fibroids thrive in an estrogen-rich environment. When a woman gets pregnant, estrogen production in her body significantly increases, which can make any existing fibroids grow larger. This normally happens in the first three or four months when hormone levels are rapidly increasing.
During the first trimester, the body also produces more blood, increasing total blood volume by around 40%. The heart works harder to keep up with the increase in blood, which flows faster. Fibroids need a blood source to thrive, and they grow in response to estrogen exposure, making the first trimester of pregnancy the perfect environment for fibroids to grow large.
Rapidly growing fibroids during pregnancy may cause symptoms like discomfort, pain, and fatigue, but symptoms can vary depending on the location of the fibroids.
Exacerbated Side Effects of Pregnancy
Large fibroids during pregnancy can exacerbate the usual side effects and make issues like morning sickness, constipation, cramping, and frequent urination more severe. Numerous fibroids or large fibroids over 6 centimeters can lead to more serious issues.
Necrobiosis
One condition that is rare but very serious when dealing with fibroids during pregnancy is necrobiosis, which occurs in 2% to 28% of pregnant women with fibroids. This condition occurs when a fibroid that has grown large during the first four months of pregnancy starts to rapidly reduce in size and degenerate due to a lack of sufficient blood supply. The degeneration process can cause severe abdominal pain, bleeding, nausea, and high body temperature. In rare cases, it may become an emergency.
Usually, by the fourth month, hormone surges have leveled out, and fibroids that may have grown larger since the onset of pregnancy may begin to shrink. However, this is not always the case, and large fibroids may continue to interfere and cause complications throughout the pregnancy.
Miscarriage Risk
Large submucosal or intramural fibroids can invade the space intended for a growing fetus and prevent proper development, resulting in miscarriage. There is also a risk of delayed development of the fetus due to lack of oxygen and nutrients coming from the placenta. Fibroids need a blood supply to live and grow and can hijack a significant amount of the blood meant for the fetus, which can have serious consequences and prevent the pregnancy from reaching full term.
Pregnancy Complications
Many women with fibroids conceive, have uneventful pregnancies, and deliver healthy full-term babies, but if you have known fibroids and become pregnant, you should be closely monitored by your doctor throughout your pregnancy.
Fibroids can increase the likelihood of experiencing problems during pregnancy as well as during delivery. Pregnant women with fibroids have an increased risk of having complications like an emergency Cesarean-section birth, breach birth, or delayed labor progression, or cause the placenta to break away (placental abruption), leading to preterm delivery, and resulting in placenta previa. Women with large fibroids are more at risk for these complications and low-birth-weight babies.
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Childbirth and Postpartum Complications with Fibroids
Delivery Challenges
Depending on the size and position of certain fibroids, they can affect the position of the baby or even block the birth canal. This can prevent a normal vaginal delivery and require a cesarean section for the safety of the mother and baby. Large fibroids can prevent the uterus from functioning the way it was intended, which can cause serious complications.
The uterus is designed to produce different types of contractions depending on the circumstances. During menstruation, the uterus contracts to shed the lining it is not going to use. During childbirth, these contractions get stronger to push out the baby. After childbirth, contractions help restore the uterus to its normal size. Large fibroids can prevent the uterus from performing these functions properly.
Risk of Postpartum Hemorrhage
One of the most serious complications a woman can experience after giving birth is severe postpartum hemorrhage (PPH). This is a condition that occurs when a woman loses too much blood after giving birth, and women who deliver by cesarean section are more at risk. Women who have C-sections are 2 or 3 times more likely to experience PPH.
Large fibroids during pregnancy can distort the uterus and interfere with its functionality. After a woman gives birth, the uterus goes through a series of contractions that help it to return to its smaller size. Fibroids may inhibit that function, resulting in a large loss of blood and postpartum hemorrhage, and they can also cause uterine atony, leading to excessive bleeding after delivery.
Fibroid Treatment and Pregnancy
Deciding When to Treat Fibroids
Women who have already been diagnosed with fibroids and are experiencing symptoms should consider treating their fibroids before they try to become pregnant. Women who have struggled with fertility issues often successfully conceive after having their fibroids eliminated.
If a woman is already pregnant when she begins showing signs of fibroids, doctors normally do not recommend eliminating the fibroids during pregnancy unless they are posing a high risk to the mother or baby. The doctor will closely monitor the mother and track the growth of the fibroids throughout the pregnancy to watch for any potential complications that could threaten the pregnancy or cause problems during childbirth.
Deciding when to remove fibroids is an individual choice that should be determined through open communication between you and your doctor. Asking questions, doing research, and not being afraid to seek out a second opinion if necessary are important.
Surgical Options and Limitations
Women suffering from uterine fibroids and interested in having children traditionally have two treatment options: a surgical option (myomectomy) and a non-surgical option called uterine fibroid embolization.
Myomectomy Surgery
Typically, OB/GYNs will only discuss treatments that they perform, such as myomectomy or hysterectomy surgery. Myomectomy is designed to preserve a woman’s uterus, but there is a chance that a patient may lose her uterus during the procedure due to excessive bleeding that cannot be controlled by the surgeon.
Surgically removing fibroids during a myomectomy involves certain risks and should be carefully considered. Any surgical cutting done on the uterus will ultimately diminish a woman’s fertility due to the resulting scar tissue it causes.
If fibroids are embedded deep in the uterine walls, the surgeon most likely will not be able to successfully remove the entire growth. If the surgeon does manage to get them out, the uterus may resemble a piece of Swiss cheese, which can compromise the strength and functionality of the uterus during pregnancy or childbirth. After a myomectomy, many doctors will not allow their patients to proceed with vaginal births, and mandatory cesarean sections must be performed.
Uterine Fibroid Embolization (UFE)
Uterine fibroid embolization (UFE), also known as uterine artery embolization (UAE), is considered the most innovative method of treating uterine fibroids, even though it has been used to treat fibroid tumors since 1991.
It is a non-surgical, fully outpatient procedure that treats all fibroids, including intramural and submucosal, which can be deeply embedded and are the ones that most often interfere with fertility and pregnancy. It allows women to keep their uterus and potentially conceive after the procedure.
UFE only takes about 45 minutes, is safer than surgery, and has only a week of recovery time versus the four to six weeks required with surgery. It eliminates fibroids by cutting off the blood supply that the fibroids have hijacked from the uterine artery without compromising the uterus or future fertility.
Patients go home the same day without any scars and usually are free from heavy bleeding and prolonged periods within a few months, and are no longer hostages to fibroids.
Fibroid Surgery vs. UFE
You may wonder why, when there is a safe, effective procedure like UFE available, it is not offered to every woman with fibroids. UFE can only be performed by an experienced interventional radiologist, like Dr. John Lipman, and requires specialized and costly medical equipment.
Most gynecologists are skilled in surgical procedures and offer myomectomy and hysterectomy, but do not perform the UFE procedure, so it is not offered as an option to their patients. Many women agree to surgery, not knowing that they have other options.
If you have been diagnosed with fibroids and have been only offered only surgical treatment, it is always a good idea to ask for a second opinion from a skilled and experienced fibroid specialist like those at the Atlanta Fibroid Center.
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Success with Pregnancy After UFE
Many patients who were having issues conceiving became pregnant after UFE, and the Atlanta Fibroid Center has an entire wall showcasing dozens of women who became mothers after having the procedure. Many of these women could not get pregnant or had numerous miscarriages before UFE and, within three to six months after UFE, became pregnant and subsequently gave birth to healthy babies.
This wall of letters from happy mothers and photos of their children is confirmation that uterine fibroid embolization is a safe, permanent, and reliable method of treating uterine fibroids for women who have fibroids and dream of becoming a mother.
Do You Have Questions About Navigating a Successful Pregnancy with Fibroids?
The experts at the Atlanta Fibroid Center can help assess your personal circumstances and determine the best course of action based on your needs. Dr. Lipman and his team understand how emotional fertility concerns can be and will ensure that you are empowered with all the information and options available to help you take control and make informed decisions regarding your reproductive health.
The team of professionals at the Atlanta Fibroid Center is not miracle workers, but they are dedicated and compassionate professionals who will go the extra mile to help you avoid surgery and improve your quality of life by eliminating fibroids safely, effectively, and with minimal downtime.
We invite you to watch this video where Dr. Lipman answers some FAQs about pregnancy and fibroids, and then fill out the form below to set up a consultation to learn more about how we can help you.
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- Board-Certified Interventional Radiologist
- Pioneer and Most Experienced Doctor in UFE
- Founder of the Atlanta Fibroid Center®
Choose a UFE-Qualified
Interventional Radiologist
UFE is a procedure that is done by an interventional radiologist and is not performed by an OB/GYN. This procedure requires a specialist with extensive training, like Dr. John Lipman at the Atlanta Fibroid Center. Together, they have over forty years of experience in treating uterine fibroids and performing the UFE procedure.
Dr. Lipman was one of the original pioneers of the UFE procedure and was the first in the state to perform it. After over 25 years and more than 10,000 completed procedures, he is known as one of the world’s leading specialists in UFE treatment for fibroids. He has treated women from all around the world, including many celebrities.
He is an advocate for women and has a mission to educate the public and legislative entities about these non-cancerous tumors through public speaking engagements and lectures. He has been instrumental in getting legislation passed in Rhode Island that provides health care coverage for non-surgical removal of fibroids through UFE fibroid treatment. He has also recently made a substantial donation to the SIR Foundation to fund research on fibroids and adenomyosis.
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