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Uterine fibroids and fertility: the lowdown

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Uterine fibroids and fertility: the lowdown

December 27, 2017   |   The Real Deal

Uterine fibroids are one of the most common conditions affecting women in their 20s, 30s, and 40s. But what are fibroids, exactly? And what’s the connection between uterine fibroids and fertility?

What is a uterine fibroid?

A fibroid is a benign (non-cancerous) tumor (overgrowth of cells). The exact cause of uterine fibroids is unknown—experts theorize that genes or hormones might have something to do with their development)—but we do know that they don’t typically indicate a cancer risk or evolve into cancer, so don’t let the word “tumor” freak you out. Fibroids are really common, and for most women, they’re NBD. The size and location of the tumor determines whether you’ll have any symptoms at all.

Uterine fibroids range from tiny (think rice grain) to large (think grapefruit or even melon), and they can be found in any part of the uterus. Fibroids located within the membrane lining the outside of the uterus—the serosa—are called “subserosal fibroids”; fibroids located in the muscular wall of the uterus are known as “intramural fibroids”; and “submucosal fibroids” are fibroids inside the interior lining of the uterus.

For women with large fibroids, multiple fibroids, or fibroids that press on other organs, the experience is a little more WTF than NBD. These women can experience long, heavy periods; irregular menstrual bleeding; pain or pressure in the pelvis, back, or legs; frequent urination; constipation; or other symptoms that affect their health and quality of life.

What’s the relationship between uterine fibroids and fertility?

For some women—though it’s uncommon—there’s a relationship between uterine fibroids and fertility that can make it difficult to get or stay pregnant. Fibroids don’t interfere with ovulation, but they can prevent the uterus from doing what it’s supposed to do to support conception and pregnancy.

The most common fibroids affecting fertility are submucosal fibroids. While the exact mechanism creating the relationship between uterine fibroids and fertility is not known, it’s possible that fibroids divert blood flow from the endometrium (uterine lining), preventing it from thickening and impeding the implantation of a fertilized egg or the development of an embryo.

More rarely, other types of fibroids can impact fertility. Subserosal fibroids on the outside of the uterus can block the cervix or fallopian tubes, obstructing the journey of sperm or a fertilized egg. And large fibroids—or multiple fibroids—that alter the structure of the uterus may cause miscarriage, because they limit the uterus’ ability to stretch and grow to accommodate a developing embryo.

There’s a relationship between the treatment for uterine fibroids and fertility, as well.

Because most women with fibroids don’t experience any symptoms, the most common treatment is no treatment at all—just “watchful waiting,” the medical term for keeping an eye on ‘em.

But for women with significant symptoms, treatment or removal might be deemed necessary for their health, comfort, and quality of life. And much like with endometriosis, it’s sometimes the treatment for fibroids that affects fertility, as opposed to the fibroids themselves. A few examples:

  • Endometrial ablation, a treatment that uses heat or energy to remove the uterine lining altogether, treats the abnormal bleeding associated with fibroids, but also makes it essentially impossible to get pregnant afterwards.

  • During uterine artery embolization, tiny particles are injected into the arteries leading to the uterus, cutting off blood flow to fibroids. While the treatment can successfully shrink and eliminate fibroid tumors, it can also compromise blood flow to the ovaries, leading to longer term acceleration of the decline in ovarian reserve, and fertility after uterine artery embolization can be affected.

  • Myomectomy, or surgical removal of fibroids, can cause scarring in the reproductive organs that may impact future fertility. (There are many different “flavors” of surgery used to remove fibroids—abdominal, laparoscopic, robotic, hysteroscopic, etc.—so it’s important to discuss the potential impact on fertility with your gynecologist before choose a plan for treatment.)

  • Hysterectomy (removal of the uterus) is a major surgery used in severe fibroid cases that eliminates the possibility of carrying children in the future, although having a child using your eggs and a gestational carrier may still be possible.

Women who hope to have children in the future have to grapple with both the symptoms of their uterine fibroids and fertility risks—a complicated and difficult decision for many.

Should women with fibroids freeze their eggs?

Freezing eggs before some fibroid treatments, such as embolization, prevents those eggs from being damaged inadvertently. And freezing eggs also offers women who are unable to get or stay pregnant on their own—because of fibroids or surgery—the chance to use those eggs later for in vitro fertilization with a surrogate.

However, it’s worth noting that women who have very large fibroids sometimes cannot freeze their eggs until after surgery, because the fibroids can be so large they prevent doctors from seeing and/or accessing the ovaries for monitoring or retrieval.

For more information about uterine fibroids and fertility, talk to your doctor.

If you have uterine fibroids and fertility is on your mind, talk to your OB/GYN about how your chance of pregnancy might be affected. And if you’re interested in freezing your eggs, contact us.

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