Part I: Can Fibroids Affect My Fertility?
By Alicia Armeli

fertility

Uterine fibroids are the most common tumors of the female reproductive system.1 Although fibroids are noncancerous, they can have serious complications, like heavy, painful periods and may even make it difficult for a woman to get pregnant.

“The majority of women who have fibroids are not symptomatic,” explains Mark Perloe, MD, infertility specialist and medical director at Georgia Reproductive Specialists in Atlanta, GA.

In fact, statistics show that fibroids are only found in about 5-10% of infertile women and may be the standalone cause of infertility in approximately 1-2%.2 But for the small number of women who are affected, fibroids can impede the intricate process of conceiving.

“Through ultrasound, we now know there are tiny micro-contractions of the uterus, and these are responsible for getting the sperm where they need to go,” Dr. Perloe tells Ask4UFE. “If there’s a fibroid, it turns out that the uterus’ contribution to moving the sperm out toward the egg or the fertilized embryo back toward the uterus may be compromised.”

In women undergoing fertility treatments, recent studies have shown that the greater number of uterine contractions per minute a woman has during insemination is significantly associated with a higher success rate, or greater number of live births.3

But the presence or absence of fertility complications depends on more than just having fibroids. Specific factors like fibroid location and size also play a part.

“A fibroid that pushes into the endometrial cavity within the uterine lining can have an adverse effect on fertility,” Dr. Perloe clarifies. “Also, if there’s a fibroid that’s larger than three centimeters in size in the wall of the uterus, it’s likely that it will interfere as well because it’s pressing on where the embryo would grow. If a woman has a fibroid that grows outside the uterus and gets pregnant—they will usually do just fine. It’s very rare that the fibroid grows to the point that it could cause problems.”

In order to remove fibroids, there are many treatments available that will provide relief, but a woman who wants to conceive must also consider whether these are fertility-friendly.

“There is no place for medical treatment of fibroids in someone wanting to conceive,” Dr. Perloe emphasizes. Medical therapy for fibroids often suppresses ovulation and disrupts hormone levels necessary to make the uterine lining ready for implantation.4 Others, like non-steroidal anti-inflammatory drugs (NSAIDs), may help with symptom relief but do not change fibroid size.2

Myomectomy, or the surgical removal of fibroids, has been a long-standing procedure that leaves the uterus intact and allows women to keep their fertility. For women who wish to become pregnant, “minimally invasive surgery such as laparoscopic myomectomy or robotic myomectomy may be the procedure of choice for women with myomas (uterine fibroids),” Dr. Perloe explains. “An MRI screening procedure is a helpful tool to make sure that all the fibroids are discovered. With robotic surgery alone, the physician is unable to palpate the uterus to determine if all fibroids have been removed.”

Finding all fibroids can help decrease the need for additional surgeries. Avoiding multiple myomectomies is important because any cuts made to internal organs can result in surgical scar tissue known as adhesions.5 Adhesions in the uterus and around the fallopian tubes could decrease a woman’s ability to conceive.5,6

Less invasive procedures like uterine fibroid embolization (UFE) and its effect on fertility are being studied. During UFE, particles are injected into the uterine arteries blocking blood flow to the fibroids, causing them to shrink. A 2015 review published by Minimally Invasive Therapy & Allied Technologies showed that fertility success rates with UFE were comparable to that of myomectomy with 48% of women getting pregnant following UFE and 46% after myomectomy.6 And there’s another up side—UFE has an approximate 90% cure rate, which means less need for subsequent procedures.6

But UFE does have its risks. Some research has shown that due to possible disruption of uterine blood flow, the ovaries could be affected, primarily among older women, resulting in early menopause. Other studies report the temporary or permanent loss of menstruation post UFE in less than 5% of patients, a complication also worsened by advanced age.2

“Shrinking the fibroids with UFE may interfere with the uterine lining afterwards because the particles that cut off the blood supply to the fibroids can also cut off blood supply to the uterine lining,” Dr. Perloe said. “UFE is contraindicated in women wanting to conceive. While fertility is fine, pregnancy outcome is compromised.”

Another minimally invasive fibroid treatment that may show promise is magnetic resonance guided focused ultrasound surgery or MRgFUS—a non-surgical procedure that uses intense ultrasound waves to destroy fibroid tissue. “MR focused ultrasound does not work in everyone, and it depends where the fibroids are located,” Dr. Perloe clarifies. “And again you may not be getting rid of the fibroid completely, so whether it’s actually improving the odds of pregnancy is unclear.” Research has shown that because of this, additional treatments may also be necessary; more long-term, larger studies are needed.6

Taking everything into account, what’s the first step for women with possible fibroid-related infertility? “The body knows what it’s supposed to do,” Dr. Perloe says. “The question is whether fibroids are standing in the way of this and interfering with getting pregnant or the outcome of pregnancy.”

Because of this, proper diagnosis of fibroids and assessment of the number, size, and location is the first step. This can help to ensure the best approach for treatment, thereby offering the greatest chances of conceiving and having a healthy pregnancy.

ABOUT THE AUTHOR   Alicia Armeli is a freelance writer and editor, registered dietitian nutritionist, and certified holistic life coach. She has master’s degrees in English education and nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and well-being. She is a paid consultant of Merit Medical.

ABOUT THE DOCTOR  Mark Perloe, MD, is an infertility specialist and medical director at Georgia Reproductive Specialists. Dr. Perloe has extensive experience treating conditions related to infertility, including menstrual disorders, uterine fibroids, endocrine and other reproductive health problems. He presently serves on the advisory board of the journal, Fertility and Sterility.

REFERENCES

  1. UCLA Health. (n.d.). Fibroids. Retrieved from http://obgyn.ucla.edu/fibroids
  2. Guo, X. C., & Segars, J. H. (2012). The impact and management of fibroids for fertility: An evidence-based approach. Obstet Gynecol Clin North Am, Dec;39(4):521-533.
  3. Blasco, V., Prados, N., Carranza, F., et al. (2014). Influence of follicle rupture and uterine contractions on intrauterine insemination outcome: A new predictive model. Fertil Steril, Oct;102(4):1034-1040.
  4. Carranza-Mamane, B., Havelock, J., Hemmings, R., et al. (2015). The management of uterine fibroids in women with otherwise unexplained infertility. J Obstet Gynaecol Can, Mar;37(3):277-285.
  5. National Institute of Diabetes and Digestive and Kidney Diseases. (2013). Abdominal adhesions. Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/abdominal-adhesions
  6. McLucas, B., Voorhees III, W. D., & Elliott, S. (2016). Fertility after uterine artery embolization: A review. Minim Invasive Ther Allied Technol, 25(1):1-7.