Fibroids & Fertility FAQ

Uterine fibroids are one of the most common structural causes of female infertility. In this FAQ, Dr. Sara Arian, a double board-certified physician in OBGYN and reproductive endocrinology at Boston IVF, provides insight into how fibroids can affect fertility, the treatment options available, and what to expect during the fertility journey.

1. What are uterine fibroids?
Uterine fibroids, also known as myomas or leiomyomas, are benign (non-cancerous) growths that develop from the muscular tissue of the uterus. They can vary in size and location within the uterus. Fibroids are incredibly common, affecting up to 75% of females of reproductive age. Despite their prevalence, many people with fibroids may not experience any symptoms.

2. What are the symptoms of uterine fibroids?
While some people may not experience any symptoms, fibroids can cause:

• Heavy or prolonged menstrual bleeding.
• Severe menstrual cramps.
• Abdominal pressure or pelvic discomfort.
• Pain during intercourse.
• Fertility complications, including difficulty conceiving and an increased risk of early miscarriage.

3. How do fibroids impact fertility?
Fibroids can affect fertility in several ways, depending on their size and location:

• Distortion of the uterine cavity: Fibroids that grow within or press against the uterine cavity (submucosal or intramural fibroids) can create an unfavorable environment for embryo implantation.
• Blockage of the fallopian tubes: Fibroids may obstruct the fallopian tubes, preventing sperm from reaching the egg or blocking the embryo’s path to the uterus.
• Changes in blood flow to the uterus: Fibroids can alter blood flow, making it harder for an embryo to implant and receive proper nourishment.

4. How are fibroids diagnosed?
Fibroids can be diagnosed using several imaging techniques, including:

• Pelvic or transvaginal ultrasound: This is usually the first step in identifying fibroids.
• Hydrosonogram (saline sonogram): A specialized ultrasound that uses saline to better visualize the uterine cavity.
• MRI: An MRI provides detailed images of fibroids and their impact on the uterus, helping with surgical planning.

5. Do all fibroids need to be removed before attempting to conceive?
Not all fibroids require surgical removal. The decision is based on their size, location, and impact on the uterine cavity. Typically:

• Submucosal fibroids (inside the uterine cavity) are most likely to impact fertility and may require removal.
• Intramural fibroids (within the muscular wall) that are large (greater than 5 cm) or cause uterine distortion may also need to be removed.
• Subserosal fibroids (outside the uterus) generally do not interfere with fertility and are left alone unless symptomatic.

6. What are the treatment options for fibroids?
Treatment options include:

• Surgical myomectomy: This is the surgical removal of fibroids. It can be performed in several ways depending on the size and location of the fibroids.
  • Hysteroscopic myomectomy: A minimally invasive procedure to remove fibroids from within the uterine cavity using a hysteroscope.
  • Laparoscopic or robotic myomectomy: Minimally invasive surgery to remove larger fibroids using small incisions and robotic assistance.
  • Abdominal myomectomy: Open surgery to remove very large or numerous fibroids through a larger incision in the abdomen.
• Medical management: Hormonal medications are sometimes used for symptomatic relief but are not recommended for individuals trying to conceive, as they can interfere with ovulation and fertility.

7. Does removing fibroids improve fertility?
In many cases, removing fibroids can improve fertility and increase the chances of a successful pregnancy, particularly if the fibroids are distorting the uterine cavity. However, surgical myomectomy is not without risks, including scar tissue formation and the need to wait several months post-surgery for the uterus to heal before attempting to conceive.

8. How long should I wait after fibroid surgery before starting IVF or trying to conceive?
Following a myomectomy, it’s typically recommended to wait at least 4 to 6 months for the uterus to heal fully before starting fertility treatments or trying to conceive naturally. This healing period helps reduce the risk of complications like uterine rupture during pregnancy.

9. Can fibroids grow back after removal?
Yes, fibroids can recur even after surgical removal. This recurrence may be influenced by factors such as hormonal changes, genetics, and incomplete removal of all fibroids. There are no definitive ways to prevent fibroids from coming back, but regular monitoring and follow-ups with your doctor can help manage them.

10. What are the risks associated with fibroid surgery?
As with any surgery, there are risks associated with myomectomy, including:

• Scar tissue formation that could complicate future pregnancies.
• Prolonged recovery time (up to 6 months before trying to conceive again).
• Potential complications with future pregnancies, such as an increased need for cesarean delivery.

11. What is the difference between a fibroid and a polyp?
Fibroids are growths of the muscle tissue of the uterus, while polyps are growths of the lining of the uterus (endometrium). Both can negatively impact fertility, but polyps are more closely associated with implantation failure and recurrent pregnancy loss.

12. Can I have a normal pregnancy and delivery if I have fibroids?
Many people with fibroids can have a normal pregnancy and delivery. The impact of fibroids on pregnancy outcomes depends on their size, location, and whether they cause complications such as pain or preterm labor. It is essential to work closely with your healthcare provider to monitor fibroids during pregnancy.

Final Thoughts
If you have uterine fibroids and are trying to conceive, it’s essential to have a thorough evaluation by a fertility specialist. The team at Boston IVF is here to provide comprehensive care and support, ensuring that you receive individualized treatment tailored to your unique needs. For more information or to schedule a consultation, please visit Boston IVF.