Uterine Fibroids & Fertility

Uterine fibroids are a common concern for many individuals with a uterus, particularly those trying to conceive. Dr. Sara Arian, a double board-certified reproductive endocrinologist and infertility specialist at Boston IVF, provides essential insights into this condition and how it can affect fertility.

What Are Uterine Fibroids?

Uterine fibroids, also known as myomas or leiomyomas, are benign growths in the uterus's muscle layer (myometrium). These growths are highly prevalent, affecting up to 75% of people with a uterus during their reproductive years. Although fibroids are non-cancerous, they can present with a variety of symptoms, some of which can significantly affect one’s quality of life and fertility.

Symptoms of Uterine Fibroids

Fibroids can vary in size and location, which contributes to a range of symptoms. While some individuals may experience no symptoms at all, others may face challenges such as:

• Heavy or abnormal uterine bleeding
• Painful menstrual cramps (menorrhagia)
• Abdominal discomfort or pressure
• Infertility or pregnancy complications

These symptoms can lead to serious conditions, such as anemia due to blood loss, which may require medical intervention.

How Uterine Fibroids Affect Fertility

Fibroids can impair fertility in several ways. According to Dr. Arian, they may cause anatomical distortion within the uterus, disrupting normal reproductive processes. For instance, fibroids can:

• Block the fallopian tubes, preventing sperm from reaching the egg
• Alter the shape of the uterine cavity, making it difficult for an embryo to implant
• Increase the risk of miscarriage or pregnancy loss

The size and location of fibroids are key factors in their impact on fertility. For example, larger fibroids (greater than 5 cm) or fibroids located within the uterine cavity (submucosal fibroids) are more likely to interfere with implantation and pregnancy.

Diagnosing Uterine Fibroids

Several diagnostic techniques are available to evaluate fibroids, including:

• Pelvic and transvaginal ultrasounds: Common initial methods for visualizing fibroids
• Hydrosonogram: A specialized ultrasound using saline to better visualize the uterine cavity
• MRI: A more advanced imaging technique used in complex cases

Treatment Options for Uterine Fibroids

The decision to treat uterine fibroids depends on several factors, including the size, number, location of the fibroids, and the patient’s symptoms and fertility goals. Dr. Arian highlights two primary treatment approaches: surgical and medical.

Surgical Options (Myomectomy)

For those trying to conceive, surgical removal of fibroids (myomectomy) is often recommended, particularly in cases where fibroids are causing significant symptoms or fertility challenges.

• Hysteroscopic myomectomy: This minimally invasive procedure is used to remove fibroids inside the uterine cavity (submucosal fibroids) through the vagina.
• Abdominal myomectomy: For larger or multiple fibroids, open or laparoscopic surgery may be needed to remove the fibroids from the uterus.
• Robotic myomectomy: A minimally invasive technique that uses robotic assistance for precise removal of fibroids.

While surgery can improve fertility outcomes, Dr. Arian emphasizes that it’s essential to weigh the risks and benefits. Recovery from myomectomy can take several months, and patients may need to delay pregnancy attempts during the healing process.

Medical Management

Hormonal medications can manage symptoms of uterine fibroids, but they are typically not suitable for individuals trying to conceive, as they can interfere with ovulation and pregnancy. These options may be considered for patients who are not actively pursuing pregnancy.

Conclusion: Take Action If You Have Fibroids

Dr. Arian urges individuals with uterine fibroids, especially those trying to conceive, to consult with a fertility specialist. Every case is unique, and a personalized approach considering the size, location, and impact of the fibroids is essential to determine the best course of action for fertility and overall health.

For anyone struggling with fibroids or infertility, seeking expert guidance from a reproductive endocrinologist, like those at Boston IVF, can help provide clarity and a path forward.