FIBROIDS AND FERTILITY
FIBROIDS AND FERTILITY
Fibroids are benign (noncancerous) tumors of the uterus. These tumors are very common and approximately 1 in 5 women over the age of 30 years has a fibroid. Uterine fibroids tend to be more frequent in African American women and less frequent in women from other ethnic groups (i.e. Asian). Most women with fibroids will not be infertile. Whether fibroids cause symptoms or require treatment depends on their location, size, and number.
Often fibroids cause no symptoms and are found during a routine GYN examination when an enlarged or irregularly shaped uterus is noted. Sometimes fibroids are found during an infertility evaluation when tests such as a pelvic ultrasound, Saline Infusion Sonogram (SIS) or Hysterosalpingogram (HSG) are performed.
There are 3 main types of fibroids based on where they are found:
Subserosal - when the fibroid grows on the outside of the uterus (55%)
Intramural - when the fibroid grows within the muscular wall of the uterus (40%)
Submucosal (intracavitary) - when the fibroid grows just under the lining of the uterine cavity (mucosa) or it occupies the inside of the uterine cavity and changes the shape of the uterine cavity. (5%)
When fibroids cause symptoms, women commonly report back pain, abdominal/pelvic pressure or discomfort, pain with sexual intercourse, urinary frequency, rectal pressure or discomfort, and periods that can be painful, heavy and prolonged.
Fibroids Effecting Your Fertility
Fibroids are associated with infertility in 5 to 10% of cases, but may account for only 2-3% of cases once other causes of infertility are excluded.
Fibroids Can Effect Fertility By:
Changing the shape of the cervix which may affect the number of sperm that can enter the uterus.
Changing the shape of the uterus which may interfere with the movement of the sperm or embryo.
Blocking the fallopian tubes so the egg and sperm cannot meet.
Affecting blood flow to the uterine cavity which can decrease the ability of an embryo to implant or develop in the uterine lining.
Women with fibroids and their partners should be thoroughly evaluated to find other problems with fertility before fibroids are treated. Treatment is decided on a case-by-case basis and the decision is dependent on the symptoms and how treatment may improve overall fertility.
Treatment of Fibroids
Most uterine fibroids don't need to be removed except in select cases such as when the uterine cavity is distorted by the fibroids. In addition, some studies also suggest removal of the fibroids if they are more than 2 inches in diameter or are located within the wall of the uterus (intramural). Otherwise, expectant (watchful) management is recommended when the woman is asymptomatic, the uterine cavity is normal, the fibroids are small, or when they are located on the surface of the uterus.
Fibroids are removed in a surgical procedure called a myomectomy. Four types of myomectomy can be performed depending on the approach: abdominal, laparoscopic, hysteroscopic, and robotic assisted. Read more about Myomectomy.
Other Fibroid Treatment Options
There are other options for the treatment of uterine fibroids, but these alternatives are not recommended for women who desire fertility. Some of these options are:
Uterine Artery Embolization (UAE) - results in the obstruction of blood flow to the fibroids, which causes them to shrink. This procedure is quite successful in reducing tumor size and decreasing symptoms. Pregnancies have been reported after UAE but the safety of this procedure in women who want to get pregnant has not been established.
Medical therapies with agents such as GnRH agonists, progestational agents, and RU486 (mifepristone) decrease fibroid size and symptoms. Once these medications are discontinued, the fibroids can grow back to their initial size. The use of these medications is not effective in promoting fertility and is not recommended when women are attempting pregnancy.
New techniques are being developed for the treatment of uterine fibroids. One of these new techniques is laparoscopic myolysis* in which a needle is used to apply electric current directly to fibroids. The goal is to disrupt the blood flow to the fibroids and cause them to shrink over time. A similar laparoscopic procedure uses super cooled cryoprobes to destroy the fibroids. Another technique uses magnetic resonance imaging (MRI) to target high intensity ultrasound waves to destroy the fibroids. Again, the safety of these procedures in women who want to get pregnant has not been established.