Do Uterine Fibroids really affect fertility?

While they may be non-cancerous, uterine fibroids are by no means harmless. Aside from the prolonged menstrual bleeding, and painful sex, some women have experienced difficulty trying to conceive. Other times, fibroids can present complications during pregnancy. While fibroids have never been proved as a direct cause of infertility, they certainly are no friend so someone trying to get a baby in them.

Fibroids are benign growths which develop from the smooth muscular uterine tissue. These ‘tumors’ affect women of reproductive age and, contrary to popular belief, fibroids are not a condition of older women only. Symptom severity ranges greatly with some women blissfully unaware of their fibroids and others wholly conscious of the troublesome mini-masses inside their womb.

The most commonly reported symptoms are prolonged and excessive menstrual bleeding, heaviness and discomfort in the abdominal region, pain during sexual intercourse as well back and leg pain. This, coupled with difficulty falling pregnant can be a huge cause of stress in a woman’s life.

The impact of fibroids on fertility has a lot to do with where the fibroid is located. While fibroids that remain small and ‘out of the way’ aren’t likely to impact your chances of having children, some fibroids can have a massive impact on the ability to conceive and when pregnant, actually carry a baby to term. Gynaecologist & Endoscopic Surgeon Dr. Natalia Novikova says that while fibroids have many problematic side effects, the most feared is the possible impact on fertility. ‘They might sometimes reduce fertility significantly though this will depend predominantly on the location of the growth. Fibroids that grow in the uterine cavity and obstruct or weaken the uterine lining or block a woman’s fallopian tubes can negatively impact implantation and the chances of healthy conception’ says Dr. Novikova.

Fibroids reduce fertility in the following ways:

  • Fibroids that are located at the opening of the fallopian tubes can cause disruption to the fertilized egg’s journey to the womb. In severe cases, the fibroids make it impossible for the fertilized egg to implant.
  • Fibroids near the cervix can impact its shape, affecting the number of sperm cells that are able to pass through to the uterus.
  • The shape of the uterus can also be affected and as a result, the fertilized egg has less opportunity for implantation. The space available for development of the embryo can also be compromised as a result.

Seeking fibroids treatment may become necessary for a woman struggling to conceive. Some women opt to treat their fibroids prior to conceiving as the presence of fibroids can be a cause of concern during pregnancy as well. Pre-natal care needs to include continuous monitoring by your gynaecologist of the fibroid development during pregnancy. Sometimes, fibroids grow as the baby grows. This growth can be quite rapid as hormone levels surge during this time, causing fibroids that were once undetectable to become visible. Fibroids have been linked to miscarriage, pre-term delivery and even contributing to an abnormal position of the fetus. In some cases, the presence of fibroids makes a C-section unavoidable to avoid the risk of heavy bleeding after giving birth. Though the chances of fibroids complicating your pregnancy are low, it’s best to keep an eye out for anything untoward.

Fibroids are typically treated via surgery with the patients’ medical history and their baby-making plans being carefully considered before choosing an appropriate treatment. A hysterectomy is an obvious no-no for women still hoping to conceive and the less extreme myomectomy is also not ideal.  A myomectomy is a procedure to surgically remove fibroids whilst preserving the uterus. Though effective, a myomectomy carries the risk of reoccurrence with a 50% chance of regrowth within 10 months should any cells remain after the procedure. If you’re having your fibroids removed to improve fertility, this gives you a pretty short window of opportunity to fall pregnant. Surgical procedures carry the risk of trauma to the organ and a myomectomy is no exception as it is often being the cause of uterine scarring. The procedure can also impact the strength of the uterus. Uterine scarring can affect the chances of successful implantation whilst weaker uterine walls can compromise the ability of the uterus to carry a baby to term.

Thankfully, non-surgical alternatives do exist. Fibroid embolisation offers women a chance to treat their fibroids without jeopardising their chances of falling pregnant.  Interventional radiologist Dr. Andrew Lawson of the Fibroid Care initiative says that ‘Fibroids are one of the many causes for women being unable to fall pregnant’ and with fibroid embolisation ‘…the fibroids are starved of blood and no longer impact the ability of the womb to carry a baby.’

Fibroid embolisation makes use of x-rays, ultrasound technology and magnetic resource imaging (MRI) to provide effective results without the need for open surgery. The treatment is conducted through a tiny incision in the wrist or groin and has become the recommended treatment in developed regions, such as the UK, where the procedure is offered via the government healthcare system. Like any medical procedure, invasive or not, there are risks. Patients of embolisation could experience a catheter-related complication whereby a hematoma may occur at the site of the incision. There is also the risk of infection which is usually treatable with antibiotics. Though highly effective, a small risk of reoccurrence does exist, in which case embolisation or an alternative method will be conducted.

Dr. Lawson, who conducts the specialised procedure throughout Southern Africa, recommends that patients’ wait 4-6 months after embolisation before trying to conceive. He also goes on to advise that in cases where fibroids are detected after pregnancy, the procedure will only be possible 6-8 weeks after the end of pregnancy.

Although uterine fibroids are by no means pleasant, we urge you not to let the presence of useless lumps of muscular tissue get you down. As troublesome as they are, fibroids are also treatable. The important thing is to be aware of your body and address any concerns as soon as they surface. In doing so, you will ensure the healthiest possible environment for that little fertilized ovum. Fibroids may make the road to conceiving a little more exhausting but they won’t push you off the path completely so keep trying!

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