Uterine fibroids are non-cancerous tumors that grow within, on, or adjoined to the uterus. Given the importance of this structure to the female reproductive system, there are concerns about the impact fibroids can, will, or have had on fertility, pregnancy, and ultimately healthy childbearing. Whether or not fibroids have an effect on fertility is especially concerning for women of childbearing years because they represent 30% of those affected by fibroids.
Examining the relationship between fibroids and fertility can help women with a history of fibroids who desire to conceive better manage their condition and select a treatment that meets both their existing health and future fertility needs. Following is a list of frequently asked questions about fibroids, fertility, and infertility.
Can Fibroids Affect Fertility?
The short answer is yes – fibroids can affect fertility. However, this relationship is complex because having fibroids does not automatically mean fertility issues will occur. Fertility can vary from woman to woman. Most women with fibroids can conceive naturally without problems, while others will experience minimal to severe complications. Differences in the effect that fibroids can have on fertility are attributed to the size, location, and a number of fibroids identified.
Most fibroids are small and cause minimal or no symptoms. When fibroids are larger, women tend to experience more severe symptoms and encounter more issues. There are three types of fibroids. They are named by their location or how they grow:
- in a stem-like fashion along the pelvis – subserosal,
- within the muscle wall – intramural,
- within the open space (cavity) or just underneath the lining of the uterus – submucosal.
If large fibroids are submucosal, they can alter the structure of the uterine cavity similar to the effect of an intrauterine device (IUD) and can prevent pregnancy from occurring. Any changes associated with the size, location, and quantity of fibroids not only affect fertility but also has the potential to cause infertility.
“With fibroids taking my body through so many hormonal changes, I grew uncertain about my ability to conceive. However, it was not the changes that most alarmed me, but the fact that the benign tumors taking residence in my uterus had the potential to rob me of my ability to conceive. As my uterus grew, so did my concerns about healthy childbearing.”
It is not enough to just consider the impacts of fibroids on fertility, it is also crucial for women to know if other factors may be causing fertility issues. Fertility problems have also been linked to age, health behaviors including smoking and excessive alcohol use, extreme weight gain or loss, and stress. Many of these same characteristics are associated with fibroid development.
Do Fibroids Affect Women Trying to Conceive?
Trying to conceive through sexual intercourse may be difficult for women with fibroids. Two common symptoms of fibroids are painful intercourse and heavy periods. This pain can be caused by pressure from fibroids pressing on the uterus or cervix. Women trying to conceive with fibroids will encounter problems if they experience abnormal periods. With fibroids, women can also experience prolonged bleeding and cramps which can make trying to conceive unrealistic. Fibroids can also decrease a woman’s sex drive, cause marked fatigue (from significant bleeding leading to anemia), and a negative body image. This negative body image is particularly true if they are forced to wear a lot of “gear” (e.g. adult diapers) to manage the heavy flow.
While most women are able to get pregnant without difficulty, trying to conceive and managing uterine fibroids can be like venturing into unknown territory. As problems arise with fibroids and women consider treatments, trying to conceive and preserving their ability to have children has become a priority. Whether or not a woman desires to conceive, studies show that uterine preservation is especially important to women under 40.
In-vitro fertilization is also a mechanism that women with fibroids use when trying to conceive. Some women are opting to have fibroids treated before using IVF, while others wait until after IVF is complete. Some women who have innumerable fibroids opt to harvest their eggs and do IVF with a surrogate to increase their chance for a successful outcome.
“While I am not at the point of trying to conceive, I am open to learning more about IVF.”
The location and number of fibroids play a key role in this decision. Almost all women struggling with fibroids and fertility have been diagnosed with a pelvic ultrasound. While this imaging tool is satisfactory for making the diagnosis, it lacks the resolution necessary to precisely determine the extent and a true number of fibroids. Magnetic resonance imaging (MRI) is the gold standard imaging tool of the pelvis. It has a significantly higher resolution and more accurately determines the size and number of fibroids which can be so important in the treatment decision process. A pelvic ultrasound, due to its lower resolution, significantly underestimates the number of fibroids in the uterus which can mislead women into thinking that surgery may eliminate all of her fibroids (which almost never occurs).
Fibroids can cause problems for women trying to conceive and interfere with every step in the fertility process from conception to delivery.
HELPFUL TIP: When trying to conceive with fibroids, learn as much as possible about your condition and fertility status. Schedule an appointment with a physician to get any questions you may have about your risk, and the best treatment approaches for healthy childbearing answered. Ask about the use of a pelvic MRI to more accurately determine the number and extent of your fibroids.
Should Fibroids Be Removed Before or After Conceiving?
Deciding when to remove fibroids is an individual choice that should be determined after speaking with a specialist. This decision will depend on many factors including whether or not fibroids are causing severe symptoms or other problems including distorting your uterus, which could affect fertility.
“I was encouraged by my doctor to have my fibroids removed in order to prevent complications when trying to conceive in the future. I did not know of or believe that there was a better treatment for me at the time”
Can Fibroids Affect Pregnancy?
Once conception has taken place, fibroids should be closely monitored by a physician. This is primarily because fibroids increase the likelihood of problems during pregnancy as well as delivery. During pregnancy, fibroids may grow. This commonly occurs during the first trimester. Symptoms such as discomfort, pain, and fatigue may also accompany growth. Of course, these symptoms will vary and depend highly upon where the fibroids are located. While pregnant, fibroids can also go undetected and untreated because of their asymptomatic nature.
Pregnant women with multiple fibroids can experience a spontaneous miscarriage. Fibroids among this group can increase Cesarean-section births, cause the baby to be breached, delay labor progression, cause the placenta to break away, and lead to preterm delivery. Although these problems are common, most pregnant women with fibroids do not experience such outcomes.
How are Fibroids and Infertility Connected?
A fibroids’ diagnosis does not automatically mean infertility. However, fibroids and infertility are linked. This is primarily explained by their location, size, and quantity.
Fibroids disrupt the normal flow of activities in the reproductive system. They can cause early termination of pregnancy, an increase in the frequency of complications related to childbirth, and the postpartum periods. Smaller fibroids are identified as the sole cause of infertility in up to 2.5% of infertile women.
Surgically removing fibroids (myomectomy) is a double-edged sword and should be approached with caution. Any surgical cutting done on the uterus will ultimately diminish a woman’s fertility due to the resulting scar tissue it causes. However, for some women, this may be necessary if pregnancy is completely impeded by the fibroids. These fibroids are typically the submucosal variety.
Can Fibroids Cause Infertility?
Uterine fibroids can cause infertility. Despite this fact, only 10% of infertile patients have fibroids.
In general, fibroids are known to disrupt implantation of the fertilized egg and embryo development, which then leads to infertility or pregnancy complications. Specifically, fibroids can cause infertility by:
- Changing the shape of the uterus,
- Changing the shape of the cervix,
- Blocking the fallopian tubes,
- Weakening the uterine wall, and
- Reducing blood flow in the uterine cavity.
Do Fibroids Cause Infertility?
Fibroids cause infertility based on their location. The location of a woman’s fibroid(s) is paramount to whether fibroids cause infertility. Although uncommon, submucosal fibroids pose the greatest threat to fertility followed by large intramural fibroids.
Fibroids cause infertility by disrupting implantation of the fertilized egg and embryo (unborn offspring) development, which then leads to infertility or pregnancy complications. Interrupting the reproductive cycle means fibroids will embed themselves in the uterus or cervix. When fibroids cause the uterus to become misshapen, they interfere with sperm and embryo movement. Less movement equals infertility. Fibroids cause infertility via a distorted cervix, which reduces the quantity of sperm entering the uterus and thus the chances of fertilization. If an embryo attempts to embed in the inner layer of the uterus atop a fibroid, it is unable to receive enough nutrients to grow and thrive.
It is also important to note that there are multiple factors that can cause infertility such as ovulation disorders, uterine or cervical abnormalities, fallopian tube damage or blockage, endometriosis, cancer, etc. Some of these factors can result from uterine fibroids.
When appropriate treatment is chosen, women have had improvements trying to conceive.
To learn more about Uterine Fibroid Embolization and infertility contact the Atlanta Fibroid Center at 770-214-4600 or make an appointment online.
About the Author: Dr. LaShanta J. Rice is the Founder and CEO of Synergy Empowerment Solutions LLC, a public health strategies and consulting company that offers tailored, in-depth trainings for individuals and organizations. She is also an adjunct professor at Liberty University Online. Previously, she served as an Assistant Professor in Psychiatry and Behavioral Sciences and as an Associate Member in the Hollings Cancer Center at the Medical University of South Carolina. She is a trained social and behavioral scientist and former Environmental Protection Agency Science to Achieve Results (STAR) Fellow. Dr. Rice was diagnosed with fibroids in 2007 and underwent a myomectomy in 2015.