Q: I am writing to you in regards to conceiving a third child with uterine fibroids. I have been blessed to give birth to two beautiful children. Will it be a problem to conceive naturally again? What are the risks to undergo IVF treatments?
A: Hello and thank you for your question.
The actual prevalence of uterine fibroids is unknown because the vast majority of women with uterine fibroids do not have any symptoms. It is estimated that 1 in 5 women of childbearing age have fibroids and around 50% of women by age 50 have fibroids.
Despite the fact that fibroids are very common in the general population it is estimated that only approximately 2% of infertility is caused by uterine fibroids. Knowing the precise location and size of the fibroids is very important when trying to evaluate a patient for potential fertility.
Fibroids that are in the uterine cavity (intracavitary), pushing on the lining of the uterine cavity (submucosal), or significantly distorting the uterine cavity (large intramural) have the greatest risk of decreasing the chances of a successful pregnancy. The best diagnostic tool to evaluate the exact location of the uterine fibroids and their effect on the uterine cavity is an MRI of the pelvis.
Fertility is multifactorial and many things have to be taken into consideration including a patient’s age and medical history. The fact that you have had two successful pregnancies is a reason to be optimistic. Additionally, any time there is an issue with fertility, the male partner also needs to be evaluated.
There are no large comprehensive studies comparing the chances of a successful pregnancy after Uterine Fibroid Embolization (UFE) versus other fibroid treatments. Most small studies did not account for differences it the patients’ ages and the fibroid sizes and location. These smaller studies often gave confusing and sometime conflicting results.
Because of this, while UFE is sometimes done in women who desire future fertility and also have other symptoms such as heavy menstrual periods, it is not commonly done as a primary treatment for infertility. This may change in the future after more research is done.
As to the specific risks involved with IVF it would be best to consult with a fertility specialist. There is no additional risk with IVF following UFE then there would be with a natural pregnancy following UFE. With uterine fibroids and any symptom, including infertility, every patient is different and a full in-person evaluation is the best way to find out what is best for you.
Adam R. Geronemus, M.D.
Associate Director, The Fibroid Center
South Miami Hospital/Miami Cardiac & Vascular Institute