Fibroids and Fertility

Fibroids are growths that occur in the uterus and vary in size and shape. They are noncancerous and normally harmless. They are often detected during routine pelvic exams. They can also occasionally lead to medical complications with potentially serious side effects.

Fibroids in and of themselves are not typically a cause of infertility however, their presence can impact pregnancy. In this article, you will learn how fibroids could impact fertility, symptoms to look out for, and, equally important, the treatment options that are available.

What Are Fibroids?

Fibroids are sometimes known as leiomyomas, or more simply, myomas. These growths can vary dramatically in size, with some remaining too small to see with the naked eye, while others growing so large that they visibly change the shape of a person’s abdomen, making them appear pregnant.

While most fibroids do not pose a threat to a person’s health, some may cause complications that require medical intervention, ranging from surgery to hormone therapy, medications, and ultrasound therapy.

Fibroids are generally categorized into three different types of growths:

• Intramural fibroids - these develop inside the muscle tissue of the uterine wall.
• Submucosal fibroids - these grow, extending inward into the uterus.
• Subserosal fibroids - these grow extending outward to the outside of the uterus.

Submucosal and subserosal fibroids are also classified as pedunculated, meaning they extend into the uterus or the area surrounding the uterus by a stalk on which the fibroid grows.

Signs of Fibroids

Fibroid growths are actually extremely common, with many people having fibroids at some point in their lives and never knowing it because they are small and/or asymptomatic.

Some symptoms of uterine fibroids include: 

Period Irregularities

Fibroids can cause heavy or unusually painful periods. At times, one can have longer and more frequent periods.

Pain

One can have pain or pressure in the pelvic region. At times, it can be pain during sex or generally in the stomach and lower back region.

In rare cases, a fibroid can grow too large and suddenly die, causing sudden severe pain in the abdomen.

Bowel and Bladder Challenges

When fibroids occur, a person can have difficulties in having bowel movements and experiencing frequent constipation. 

At times the difficulty is in urination. They may urinate either too frequently or have difficulty in passing urine altogether.

Physical Changes

A fibroid can become so large a growth, that it distorts the appearance of the abdominal region.

Causes of Fibroids

The root cause of fibroids remains unknown. It is unclear if there is any one specific factor that leads to their development, or whether it is a combination of factors. 

However, there is evidence that small growths in the uterus can grow quite rapidly when exposed to the hormone estrogen. This, in turn, can lead to the uncontrolled expansion of abnormal tissues.

Johns Hopkins University suggests there are certain factors linked to the development of fibroids. In general, females of reproductive age are more likely to develop fibroids than prepubescent individuals or those who have gone through menopause. 

Further, there are some factors related to genetics and others related to lifestyle. Additional risk factors include high blood pressure, a diet high in red meat, obesity, and a family history of fibroids.

Johns Hopkins also notes that women of color have a higher rate of fibroid development and more often require treatment, although there is no existing research that explains why this might be the case.

How Fibroids Are Treated

Typically, fibroids are treated with either prescription medication or surgery. A majority of fibroids do not require any treatment and, in fact, go undetected for years without causing any issues, such as infertility. 

In instances where pain, bleeding, or other concerning symptoms present themselves, medical intervention may be necessary. Medical intervention in a majority of cases has not resulted in infertility as a side effect.

Nonsurgical Options

Thanks to recent medical advances, a variety of treatments for fibroids that do not require surgery have been uncovered. They include hormone-based and medicine-based treatments.

In addition, new procedures have been developed, which show promising results in treating fibroids without surgery. These treatments work well especially when symptoms are mild, or are caused by smaller fibroids.

Hormone-based Treatments

Several hormone treatments have shown promising results in shrinking fibroids or alleviating their symptoms. The medications that are used fall under a classification known as gonadotropin-releasing hormone agonists (GnRHa). 

These medications work to reduce the levels of estrogen in the body, which otherwise would ‘feed’ the fibroids. The effects of reduced estrogen can slow and even reverse the growth of fibroids.

GnRHa treatments are intended for short-term use only, most commonly, ahead of a surgical procedure to increase its likelihood of success. Long-term use can have serious undesirable side effects. 

Medication-based Treatments

Medicine-based treatments typically focus on addressing the symptoms of fibroids. One of the most common forms of treatment is the use of prescription oral contraceptive pills. 

By reducing the size of the endometrium, birth control pills have been shown to reduce the excessive bleeding that can be caused by many problematic fibroids.

Uterine Fibroid embolization

This is a procedure whereby blood flow to the fibroid is blocked using a small catheter inserted close to the fibroid. This has been shown to damage the fibroid, making it shrink by as much as 50 percent.

Ultrasound-based treatment

This treatment uses focused, high-energy sound waves to destroy fibroids without harming the surrounding tissue. It has been observed 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.

Surgery

Surgically, there are a variety of options available for the removal of fibroids. The procedure depends on the size of the growths as well as the health, age, and future family planning of the patient.

Hysteroscopic Myomectomy 

This procedure is typically used for small, problematic fibroids. It is short and can be performed during a one-day outpatient process. 

A hysteroscope, or small camera, is inserted into the uterus through the cervix and used to locate the fibroids. A small surgical instrument is then inserted and used to cut or burn away the growth.

Laparoscopic Myomectomy

This procedure is similar to a hysteroscopic procedure, and is typically applied on larger fibroids.  This surgery is also typically a one-day outpatient procedure.

Where fibroids may be larger than heterotopic procedure might accommodate, the laparoscopic procedure is performed by making incisions in the lower abdomen. This allows for the ease of their removal. 

Full Hysterectomy

This is the one medical intervention that causes infertility. In this procedure, the full uterus is taken out of an individual’s body. This not only definitively ends the development of fibroids but also prevents pregnancy and menstruation from ever occurring.

This process is done under some form of sedation, either general or local anesthesia, to prevent patient discomfort during the procedure.

It is important to note that this drastic procedure is usually done under unique circumstances when recurring fibroids represent a debilitating issue and individuals do not intend on having children in the future.

Summing It Up

Fibroids are uterine growths that are generally harmless and, in fact, do not raise any concern as far as cancer is concerned. However, their presence can cause other complications that require medical intervention. 

They are often detected during routine pelvic check ups, and in the event that occurs, guidance by a professional healthcare provider is necessary in order to determine the best course of treatment.

If you have further concerns or questions about fibroids or need help in finding appropriate treatment for issues related to fibroid growth, Ivy Fertility can be of assistance. We offer a wide range of reproductive services at various locations across the country.

Frequently Asked Questions (FAQS)

Can Fibroids Affect My Pregnancy?

Yes and no. The majority of people with fibroids will not experience complications related to these growths during pregnancy. Sometimes however, complications can arise throughout a pregnancy depending on the size and quantity of fibroids within the uterus.

What Complications Arise from Fibroids in Pregnancy?

A study on the management of fibroids in pregnancy found evidence that shows pregnant women who have untreated fibroids had an increased likelihood of conditions such as spontaneous miscarriage, preterm labor, placenta abruption, malpresentation, labor dystocia, cesarean delivery, and postpartum hemorrhage.

When Should I See a Doctor?

If you experience the sudden onset of symptoms of fibroids or if existing symptoms become disruptive to your daily life, you should contact a medical professional for assessment and information about the appropriate next steps for treatment. 

In the event of sharp, sudden abdominal pain that is unresponsive to pain medication, or if you experience severe vaginal bleeding accompanied by lightheadedness, fatigue, and weakness, seek immediate emergency care as it could indicate more serious complications relating to fibroids.