Women often wonder if uterine fibroids will affect their ability to conceive and carry a child. The answer is generally yes, though these growths may introduce certain complications. Uterine fibroids are very common, and most women who have them can conceive naturally and have a successful pregnancy. Understanding the characteristics of fibroids and how they interact with the reproductive system is key to managing potential challenges.
What Are Uterine Fibroids
Uterine fibroids, also known as leiomyomas, are non-cancerous tumors that grow in the muscular wall of the uterus. They are composed of smooth muscle cells and fibrous connective tissue. Fibroids range in size from microscopic to large masses that can significantly alter the shape of the uterus. They are the most common noncancerous tumor of the reproductive tract and are not linked to an increased risk of uterine cancer.
Fibroids are categorized based on their location within the uterus, which influences their potential effects. The most common type is the intramural fibroid, embedded within the muscular wall of the uterus. Subserosal fibroids grow on the outer surface of the uterus, sometimes extending into the pelvis.
The third type, submucosal fibroids, grows just beneath the inner lining and protrudes into the uterine cavity. A less common variation is the pedunculated fibroid, which is attached to the uterus by a stalk. This can occur with either subserosal or submucosal fibroids. The location of the fibroid is a major factor in determining whether it will cause symptoms or interfere with fertility.
Impact on Conception and Fertility
A woman’s ability to conceive is most directly affected by the fibroid’s location, with submucosal fibroids presenting the highest risk of fertility impairment. These growths distort the shape of the uterine cavity, the space where an embryo must implant. This distortion can interfere with the implantation process, potentially lowering the rate of successful embryo attachment.
Submucosal fibroids, and large intramural fibroids that bulge into the cavity, are associated with lower pregnancy and live birth rates. This is particularly true for women undergoing assisted reproductive technologies like in vitro fertilization (IVF). The presence of fibroids may also create an unfavorable uterine environment by impairing blood flow to the endometrial lining or causing subtle changes in the local hormonal environment.
In rare instances, large fibroids can physically block the fallopian tubes, preventing the egg and sperm from meeting. Subserosal fibroids, which grow on the outside of the uterus, typically do not interfere with conception or embryo implantation. For women with unexplained infertility or recurrent pregnancy loss, removing fibroids that distort the uterine cavity has been shown to improve pregnancy rates.
Managing Fibroids During Gestation
For women who successfully conceive, fibroids can introduce specific risks during pregnancy. Although most women with fibroids have uncomplicated pregnancies, the growths can sometimes lead to adverse outcomes. Fibroids may grow during gestation due to pregnancy hormones, potentially leading to increased pain or discomfort.
A common complication is red degeneration, where a fibroid outgrows its blood supply and begins to die, causing severe localized pain, typically in the second or third trimester. This pain is usually managed conservatively with rest, hydration, and pain relief medications like acetaminophen. Nonsteroidal anti-inflammatory drugs (NSAIDs) are generally avoided in later pregnancy.
Fibroids can also increase the risk of complications such as miscarriage, especially in the first trimester, and are associated with a higher rate of preterm labor. If a fibroid is located near the placenta, it can increase the risk of placental issues, including placental abruption. Furthermore, large fibroids may obstruct the birth canal or cause the fetus to be in an abnormal position, such as breech presentation, often necessitating a cesarean delivery.
Pre-Conception Treatment Strategies
For women with symptomatic fibroids or those whose fibroids impair their ability to conceive, treatment options are available before attempting pregnancy. The primary fertility-preserving surgical procedure is a myomectomy, which involves physically removing the fibroids while leaving the uterus intact. The surgical approach is determined by the fibroid’s location: hysteroscopic removal is used for submucosal fibroids, while abdominal or laparoscopic surgery is used for intramural and subserosal fibroids.
Myomectomy is often considered the most effective option for women who wish to preserve their fertility. It has been shown to improve pregnancy rates, particularly when submucosal fibroids are removed. Following the procedure, women are generally advised to wait at least three to six months before attempting conception. This waiting period allows the uterine wall to fully heal, minimizing the risk of uterine rupture during a subsequent pregnancy.
Another less invasive option is Uterine Fibroid Embolization (UFE), which blocks the blood supply to the fibroids, causing them to shrink. UFE is a viable treatment for symptomatic fibroids, but its impact on future fertility is still under discussion. For women prioritizing future pregnancy, myomectomy is often the preferred and more traditional approach. A thorough discussion with a specialist is necessary to choose the best treatment based on the fibroid’s characteristics and the woman’s specific goals.