Uterine Fibroids and Fertility

Uterine fibroids are associated with both infertility and miscarriage depending on their size and location. However, not everyone with fibroids, even large ones, will have difficulty. Uterine fibroids are benign growths of the uterus. They are derived from a single overgrown muscle cell. They are also called leiomyomas or myomas. They do not increase the risk of uterine cancer. The cause of fibroids is not well understood. There appears to be a genetic component and they grow in response to estrogen and perhaps even progesterone. Here are the most common questions on uterine fibroids and fertility that we receive.

The 3 Most Common Types of Fibroids

There are three common types of fibroids: those that grow on the outside of the uterus called subserous fibroids; those that grow within the wall of the uterus called intramural fibroids; and those that grow in the endometrial cavity called submucous fibroids. Fibroids often cause symptoms including heavy bleeding, prolonged periods, and pain. Depending on their size and location they can interfere with bowel and bladder habits. Fibroids can also exist without symptoms.

Which Kind of Fibroid Causes Infertility?

Fibroids are associated with infertility due to implantation difficulty and restricted growth leading to miscarriage. IVF success rates are decreased by fibroids especially if they are compromising the intrauterine cavity. Fibroids that do not interfere with the uterine cavity but are intramural and over 5 cm in diameter may also compromise fertility most likely due to interfering with uterine blood flow. Subserous fibroids do not appear to have a significant impact on fertility but may cause pain and discomfort. Preterm delivery and abnormal positioning of the baby within the uterus may be caused by fibroids.

What Is the Best Treatment for Fibroids?

While hysterectomy remains the definitive treatment for fibroids, therapies designed to spare fertility include operative hysteroscopy with resection of submucous fibroids, laparoscopic myomectomy, and abdominal myomectomy for intramural and subserous fibroids. Other palliative therapies include uterine artery embolization and magnetic resonance guided focal ultrasound ablation. These modalities, although effective in reducing fibroid growth, future fertility remains a concern. Current evidence favors resection and myomectomy over other approaches.