Fibroids, also known as uterine leiomyomas, are common noncancerous growths that develop within the muscular walls of the uterus. These benign tumours can affect women of reproductive age and occasionally pose challenges to their fertility. As a doctor, it is crucial to have a deep understanding of how fibroids can impact fertility and be equipped with the knowledge to guide patients effectively. In this blog, we will explore the relationship between fibroids and fertility, discuss diagnostic approaches, and explore potential treatment options.
Fibroids can vary in size, number, and location within the uterus. They can be submucosal (protruding into the uterine cavity), intramural (within the uterine wall), or subserosal (projecting outside the uterus). While many women with fibroids do not experience any symptoms, others may suffer from heavy menstrual bleeding, pelvic pain, frequent urination, or difficulty conceiving.
Impact on Fertility:
Fibroids can affect fertility through several mechanisms:
Distortion of the Uterine Cavity: Submucosal fibroids, when located within the uterine cavity, can alter their shape, potentially interfering with the implantation of a fertilized embryo.
Changes in Blood Flow: Larger fibroids may disrupt blood flow to the uterus, which can compromise the ability of the embryo to implant successfully.
Mechanical Obstruction: Fibroids that are located near the cervix or within the Fallopian tubes can create physical barriers, hindering sperm migration or embryo transport.
Hormonal Imbalances: Fibroids can interfere with the normal hormonal milieu necessary for successful conception and implantation.
Diagnosis: Accurate diagnosis is essential to determine the impact of fibroids on fertility. Diagnostic approaches may include:
Pelvic Examination: Physical examination of the pelvis may reveal the presence of an enlarged or irregularly shaped uterus.
Imaging Studies: Ultrasonography, hysterosalpingography, or magnetic resonance imaging (MRI) can provide detailed information about the size, number, and location of fibroids.
Hysteroscopy: A minimally invasive procedure using a thin, lighted tube (hysteroscope) to examine the uterine cavity and identify submucosal fibroids.
Treatment Options for Fibroids.
The choice of treatment depends on the patient’s symptoms, The desire for fertility, and fibroid characteristics. Several options are available:
Watchful Waiting: If fibroids are small and asymptomatic, a conservative approach may be appropriate, with regular monitoring for any changes.
Medications: Hormonal medications, such as gonadotropin-releasing hormone agonists, can temporarily shrink fibroids and alleviate symptoms. However, they are not a definitive solution for fertility concerns.
a. Myomectomy: This surgical procedure is performed during the removal of fibroids and preserving the uterus at the same time. Myomectomy can be performed hysteroscopically, laparoscopically, or through an open abdominal incision (laparotomy).
b. Uterine Artery Embolization (UAE): In this minimally invasive procedure, the blood supply to the fibroids is blocked, causing them to shrink. The UAE is an option for women who wish to preserve fertility.
c. Magnetic Resonance-guided Focused Ultrasound Surgery (MRg FUS): This non-invasive procedure uses focused ultrasound waves to heat and destroy fibroids, providing symptom relief.
Assisted Reproductive Technologies (ART): In cases where fibroids have a significant impact on fertility, in vitro fertilization (IVF) is the treatment of choice.
What if, fibroids are found during pregnancy?
The biggest concern is whether the fibroid will cause or increase preterm birth or miscarriage.
Fibroids are supplied with blood supply and can cause severe pain for which, hospitalization might be needed. Fibroids can push or change the baby’s position in the uterus and can increase the risk of miscarriage, preterm delivery, and cesarean section.
If a conception happens after a fibroid removal, one should discuss this aspect on priority with the obstetrician. This will help a doctor to take precautions and care while delivering the baby. A cesarean section may be recommended.
Let’s know the impact of fibroids on fertility in a nutshell.
Uterine fibroids are a common concern. Uterine fibroid affects 20% of women (1 in 5 women) of childbearing age. It can affect fertility in many ways. They can affect the way sperm and egg meet, embryo implantation, the progress of pregnancy, and the growth and positioning of the baby.
Treatment is oriented depending on the symptoms and severity of fibroids and may improve overall fertility. Non-interfering uterine fibroids are treated medically and monitored for growth in the future.
Fibroids arise probably due to hormonal, genetic and environmental factors or a combination of any but there is no definitive cause of uterine fibroids. Depending on the uterine fibroid’s location, size and number, these noncancerous tumours cause pain, bleeding and infertility and greatly impact your quality of life.
Surgery is not always an option. Not all fibroids grow enough to interfere with pregnancy. However, such uterine fibroids if left unchecked, may interfere with pregnancy and can complicate pregnancy. However, treatment for all cases depends on the right diagnosis, age etc.
In the case of Assisted Reproduction Technologies, fibroid location is of critical importance, submucosal fibroids, in particular, significantly reduce implantation and pregnancy rates of ART.
Fibroids are estrogen-driven and growth can be reduced or increased. The wise decision is never to miss any sign.
Do consult Pearl Women’s Hospital and Yash IVF for any treatment for uterine Fibroids.