Fibroids and infertility: There is a solution

Uterine fibroids are common and can affect fertility in many ways. They can affect whether sperm and egg meet, they can affect whether an embryo can implant, they can affect whether a pregnancy can continue, and they can affect the growth and positioning of the baby.

Uterine fibroids are benign tumors that form in your uterus. Also known as myomas or leiomyomas, fibroids come in different shapes, sizes, and locations. Some women may only have one fibroid, while others have many. There are also different types of fibroids based on where they’re found in the uterus or cervix. Fibroid location is what determines whether infertility can occur.

Generally, there is divided opinion about why fibroids occur.  During your reproductive years, your reproductive hormones, that is, estrogen and progesterone levels are high. High estrogen levels promote growth of fibroids while low estrogen levels cause fibroids to shrink, for instance, during the menopause.
Fibroids have a genetic factor. If your mother or sisters have/had fibroids, you would have a higher risk. In most cases, the symptoms of fibroids are rarely felt and you may not know that you have them. They are usually discovered during an incidental examination or ultrasound scan.
Generally, most women have no symptoms of fibroids, but when symptoms do develop, they may be severe. Common examples include heavy periods, backache, constipation, and discomfort in the lower abdomen if the fibroids are large.
Frequent urination, heavy painful periods, pain in the legs, painful sex, and swelling in the lower abdomen are other symptoms.

About one in five women develop fibroid issues at some time during their life, however, clinical evidence shows that women aged between 30 and 50 are the most likely to be diagnosed.
If you are overweight and obese, you could be more at risk if the fibroid is inside the womb, it could affect conception or if there is pregnancy, it could be lost.
It is not unusual to have fibroids removed in order to get pregnant, however there could be underlying factors contributing to infertility besides fibroids. A woman may have fibroid and it may not disturb her, but if it disturbs her, she should have it checked or removed.
Having fibroid is not normal. Fibroids can change the shape or size of the uterus and sometimes the cervix (lower part of the uterus). Fibroids could also interfere with conception if located around the Fallopian tubes.
You may have more than one fibroid tumour but single fibroids are possible. Whether fibroids cause symptoms or require treatment depends on their location, size, and number.

As earlier mentioned, fibroids can decrease fertility. Approximately 5–10 per cent of infertile women have fibroids. Their size and location determines whether fibroids affect fertility. Examples include fibroids that are inside the uterine cavity (submucosal) or very large within the wall of the uterus (intramural).
Most women with fibroids will not be infertile. If you have fibroids, you and your partner should be thoroughly evaluated to find other problems with fertility before fibroids are treated.
A fertility specialist can help assess if fibroids might be hampering conception.
There are several ways uterine fibroids can reduce fertility. Changes in the shape of the cervix can affect the number of sperm that can enter the uterus. Changes in the shape of the uterus can also interfere with the movement of the sperm or embryo.
The fallopian tubes can be blocked by fibroids that can impact the size of the lining of the uterine cavity.
Also, blood flow to the uterine cavity can be affected. This can decrease the ability of an embryo to stick (implant) to the uterine wall or to develop.

Fibroids are found in many pregnant women, but not all fibroids get larger or cause problems in a pregnancy. If a fibroid grows, it usually does so in the first 12 weeks of pregnancy.
The biggest concern in pregnancy is whether the fibroid will increase the chance or preterm birth or miscarriage. In some cases, fibroids can outgrow their blood supply and cause severe pain. Hospitalisation might be needed. Also, if pregnancy occurs, fibroids can change the baby’s position in the uterus. This can increase the risk for miscarriage, preterm delivery, and cesarean section.
How fibroids are managed depends on your unique situation and your doctor’s recommendations. Surgery is rarely necessary or performed during pregnancy.
If you conceive after having a fibroid removed, you should discuss this with your obstetrician. A cesarean section may be recommended.
Treatment is decided on a case-by-case basis. It is based on the symptoms of fibroids and may improve overall fertility. How and whether you treat your fibroids depends on the severity of your symptoms and your doctor’s recommendations.

Once you’ve been diagnosed with uterine fibroids, your first question might be if fibroids cause infertility. It depends on the location of the fibroids.  Because the location of your fibroids may be a factor, it’s important to recognise the symptoms of uterine fibroids so you and your doctor can decide on a treatment plan.
If you are experiencing fertility issues, common signs of fibroids include heavy and prolonged menstruation between or during your periods.

Other signs such as anemia, which can lead to fatigue, pain during intercourse, frequent urination, constipation and/or bloating, increased menstrual cramping and stomach swelling are all suspicious.
Infertility due to fibroids depends on how and where your fibroids are growing. Many women who have uterine fibroids go on to become pregnant, while others may face difficulty. Submucosal fibroids can disrupt implantation and embryo growth, which may lead to infertility or pregnancy complications.

You may be concerned that treating your fibroids may also affect your fertility. Many women are told that hysterectomy – the surgical removal of the uterus– is their only treatment option. Because hysterectomy results in permanent infertility, it’s not a good option for women that want to get pregnant. There are other treatment options that can relieve your fibroid symptoms while allowing your fertility to be preserved.

You shouldn’t have to choose between preserving your fertility and treating painful fibroid symptoms. If you are concerned about fibroids and infertility, contact your gynecologist who would refer you to a fertility specialist if necessary.

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