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

fertility

Uterine fibroids are a common gynecological condition affecting as many as 1 in 5 women of childbearing years.1 Although these tumors are benign, 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,” explained Dr. Mark Perloe MD, an infertility specialist and Medical Director at Georgia Reproductive Specialists in Atlanta. In fact, statistics show that fibroids are only found in about 5-10 percent of infertile women and may be the standalone cause of infertility in approximately 1-2 percent.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 told 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 clarified. “Also, if there’s a fibroid that’s larger than 3 cm 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 emphasized. 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), can be used to 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 explained. “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.”

And 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 that grow in and around the uterus could decrease a woman’s ability to conceive6 and the more surgeries a woman has, the higher the risk for adhesions.5

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 Technologies6 showed that fertility success rates with UFE were comparable to that of myomectomy with 48 percent of women getting pregnant following UFE and 46 percent after myomectomy. And there’s another up side—UFE has an approximate 90 percent cure rate, which means less need for subsequent procedures.

But UFE does have its risks as well. Some research has shown that due to possible disruption of uterine blood flow, the ovaries could be affected resulting in early menopause.6 Other studies report the absence of menstruation post UFE and possible damage to the uterine lining.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 clarified. “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, recurring 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 said. “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 Health Freelance Writer, 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 wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering with her local animal shelter.

ABOUT THE DOCTOR Mark Perloe 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 of Fertility and Sterility.

REFERENCES

  1. US National Library of Medicine. (2014). Uterine Fibroids. Retrieved September 16, 2015, from https://www.nlm.nih.gov/medlineplus/ency/article/000914.htm
  2. Guo, X. C., & Segars, J. H., (2012). The impact and management of fibroids for fertility: an evidence-based approach. Obstetrics & Gynecology Clinics of North America, 39(4): 521-533. doi:  10.1016/j.ogc.2012.09.005
  3. Blasco, V., Prados, N., Carranza, F., Gonzalez-Ravina, C., Pellicer, A., & Fernandez-Sanchez, M. (2014). Influence of follicle rupture and uterine contractions on intrauterine insemination outcome: a new predictive model. Fertility and Sterility, 102(4): 1034-1040. doi: 10.1016/j.fertnstert.2014.06.031.
  4. Carranza-Mamane, B., Havelock, J., Hemmings, R., Reproductive Endocrinology and Infertility Committee, Cheung, A., Sierra, S., Carranza-Mamane, B., Case, A., Dwyer, C., Graham, J., Havelock, J., Hemmings, R., Liu, K., Murdock, W., Vause, T., Wong, B., Burnett, M., & Society of Obstetricians and Gynaecologists of Canada. (2015). The management of uterine fibroids in women with otherwise unexplained infertility. Journal of Obstetrics and Gynaecology Canada, 37(3): 277-288.
  5. National Institute of Diabetes and Digestive and Kidney Diseases. (2013). Abdominal Adhesions. Retrieved October 12, 2015, from http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/abdominal-adhesions/Pages/facts.aspx
  6. McLucas, B., Voorhees Iii, W. D., & Elliott, S. (2015). Fertility after uterine artery embolization: a review. Minimally Invasive Therapy & Allied Technologies, 2: 1-7.