It is possible to get pregnant when you have uterine fibroids, but the relationship is complex and depends heavily on the fibroids’ characteristics. Uterine fibroids are common, non-cancerous growths that form in the muscle wall of the uterus, affecting many women of reproductive age. While fibroids do not automatically cause infertility, their size and location can interfere with conception and sustaining a pregnancy.
Understanding Uterine Fibroids
Uterine fibroids, also known as leiomyomas, are benign tumors composed of smooth muscle cells and fibrous connective tissue. They can range in size from tiny seedlings to large masses that enlarge the uterus. Many women with fibroids never experience symptoms, but for others, they can cause heavy menstrual bleeding, prolonged periods, and pelvic pressure or pain.
Fibroids are classified into different types based on where they grow within the uterine wall, which determines their impact on fertility. Submucosal fibroids grow just beneath the uterine lining and protrude into the uterine cavity. Intramural fibroids grow within the muscular wall, and subserosal fibroids develop on the outer surface.
Submucosal fibroids are the most problematic type for conception because of their position inside the uterine cavity. Other types, such as subserosal fibroids, typically have a much smaller impact on the ability to become pregnant.
Impact on Conception and Fertility
Fibroids can interfere with a woman’s ability to conceive through several specific mechanisms related to their location and size. Submucosal fibroids are the most strongly linked to reduced fertility, as they physically distort the uterine cavity. This distortion can interfere with embryo implantation into the uterine wall, which is necessary to establish a pregnancy.
Large intramural fibroids that distort the uterine cavity can similarly hinder implantation or affect blood flow to the uterine lining. In some cases, fibroids can block the fallopian tubes, preventing the sperm from reaching the egg or the fertilized egg from traveling to the uterus. The presence of fibroids that deform the cavity is considered a potential barrier to conception, especially in cases of unexplained infertility.
Managing Fibroids During Pregnancy
Once conception is successful, the presence of fibroids can introduce potential complications, though most women still have healthy pregnancies. Hormonal changes during pregnancy can sometimes cause fibroids to grow. A common complication is pain, which occurs when a fibroid outgrows its blood supply and begins to degenerate.
Fibroids are associated with an increased risk of miscarriage, especially when the fibroid is large or located near where the placenta attaches. They also increase the risk of preterm labor and preterm birth. Later in pregnancy, large fibroids can interfere with the baby’s position, leading to fetal malpresentation.
Management during pregnancy is generally conservative, focusing on monitoring and symptom relief, as surgical removal is rarely performed due to the risks of bleeding and premature delivery. Pain caused by fibroid degeneration is managed with rest, hydration, and appropriate pain relievers like acetaminophen. Fibroids can also increase the likelihood of needing a Cesarean delivery if a large fibroid blocks the birth canal.
Treatment Options Before Conception
For women whose fibroids are preventing conception, treatment before attempting pregnancy can significantly improve outcomes. The primary surgical option to preserve fertility is a myomectomy, which is the surgical removal of the fibroids while leaving the uterus intact. The type of myomectomy performed—hysteroscopic, laparoscopic, or abdominal—depends on the fibroids’ size, number, and location.
Hysteroscopic myomectomy is used for submucosal fibroids and allows for a rapid recovery, requiring a wait of one to three months before trying to conceive. Laparoscopic or abdominal myomectomies, used for intramural or larger fibroids, require a longer healing period. Doctors recommend waiting three to twelve months to ensure the uterine wall has fully healed, which prevents complications like uterine rupture during a future pregnancy.
Uterine Fibroid Embolization (UFE) is a less invasive, non-surgical option that works by cutting off the blood supply to the fibroids, causing them to shrink. While UFE can be effective for managing symptoms, it is less recommended than myomectomy if future fertility is the primary goal. However, recent data suggests pregnancy is possible after UFE, making a thorough consultation with a specialist essential.